Quick answers Does Iowa Specialty Hospital - Belmond have an emergency room? Yes. Medicare (CMS) data lists emergency services at Iowa Specialty Hospital - Belmond. In a medical emergency, call 911. Where is Iowa Specialty Hospital - Belmond? 403 First Street SE, Belmond, IA 50421, in Wright County, Iowa. What is the phone number of Iowa Specialty Hospital - Belmond? (641) 444-3223, as listed by Medicare (CMS). What is the Medicare star rating of Iowa Specialty Hospital - Belmond? CMS does not show an overall star rating for this hospital. This is common, for example when a hospital reports too few quality measures or is not part of the rating program. Specialties and care areas[4] [8] Show all 29 IV Infusion Therapy Visiting Nurse Services MRI CT scan Bone densitometry Diagnostic X-rays Digital mammography Ultrasound Echocardiography Nuclear medicine (mobile) Emergency care (hospital website)[5] Emergency room Yes Open 24/7 Yes Trauma designation Level IV
Doctors and clinicians (93) 93 doctors and other clinicians list Iowa Specialty Hospital - Belmond as a hospital where they work, in Medicare's official clinician data (updated 2026-10-02). It is not a complete staff list.
Main specialties Doctors with a page on this site (93) Abbie G. White, NP Nurse Practitioner Abby L. Young Nurse Practitioner Alexander C. Conley, PA Physician Assistant Alicia M. Oneill Nurse Practitioner Amanda R. Tew, DO Family Practice Amber L. Campbell Nurse Practitioner Amber R. Kramer Nurse Practitioner Amy E. Faga Nurse Practitioner Andrea M. McLoughlin, MD Family Practice Andrew J. McMurray, DO Family Practice Andrew N. Odland, MD Orthopedic Surgery Anna R. Holzer, MD Family Practice Benjamin D. Becker Physician Assistant Betsey K. Bean, DO Orthopedic Surgery Carla L. Aldrich, CNA Certified Registered Nurse Anesthetist (CRNA) Carrie J. Reese Nurse Practitioner Carrie M. Potter Nurse Practitioner Christian P. Ledet, MD Pain Management Christopher E. Adams, MD Urology Chrysten R. Dohrmann Nurse Practitioner Cori N. Walker, MD Otolaryngology Courtney R. Makus Nurse Practitioner Daniel J. Lee, MD Otolaryngology Danielle M. McMillen, DO General Surgery And 69 more: the button below opens the full list.
See all 93 clinicians Other emergency rooms nearby Hospitals that list emergency services, by straight-line distance (not driving distance).
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About the Medicare star rating CMS (the federal Medicare agency) gives many hospitals an overall rating from 1 to 5 stars, based on measures of mortality, safety, readmissions, patient experience and timely care. It is one piece of information: ask your doctor what matters for your care. See the full Medicare profile →
Medicare quality data What Iowa Specialty Hospital - Belmond reported to Medicare (CMS), the federal agency that publishes these results for hospitals nationwide. These are averages for many patients, not a prediction for any one person: ask your doctor what matters for your care. In a medical emergency, call 911.
What patients said (patient survey) What this means: Patients who stayed overnight answered a national survey (HCAHPS) about their stay. More stars mean patients reported a better experience than at other hospitals. The percentages show how often patients gave the best answer, next to the national average.
Summary star rating (all survey topics) Not reported to Medicare Overall rating of the hospital Not reported to Medicare Would recommend the hospital Not reported to Medicare Nurses communicated well Not reported to Medicare Doctors communicated well Not reported to Medicare Staff explained medicines Not reported to Medicare Information about recovery at home Not reported to Medicare Room and bathroom kept clean Not reported to Medicare Quiet at night Not reported to Medicare Rated the hospital 9 or 10 out of 10 85% National average: 72% Would definitely recommend the hospital 77% National average: 71% Nurses “always” communicated well 84% National average: 80% Doctors “always” communicated well 88% National average: 80% Staff “always” explained medicines before giving them 67% National average: 62% Were given information about recovery at home 87% National average: 86% Room and bathroom “always” clean 79% National average: 74% Area around the room “always” quiet at night 78% National average: 60% Completed surveys 87Response rate: 39%
Source: Patient survey (HCAHPS) - Hospital — CMS, released July 22, 2026; patients discharged October 2024 to September 2025.
Infections caught in the hospital What this means: CMS compares the number of infections patients caught in this hospital with the number expected for a hospital like it. The number shown is that ratio: below 1 means fewer infections than expected, above 1 means more. “Better” or “worse” is shown only when the difference is clear in the data.
Central line bloodstream infections (CLABSI) Not reported to Medicare Catheter-associated urinary tract infections (CAUTI) Not reported to Medicare Surgical site infections after colon surgery Not reported to Medicare Surgical site infections after abdominal hysterectomy Not reported to Medicare MRSA bloodstream infections Not reported to Medicare Clostridioides difficile (C. diff) intestinal infections Not reported to Medicare
Source: Healthcare Associated Infections - Hospital — CMS, released July 22, 2026.
Complications and deaths What this means: Death rates are the share of patients who died within 30 days of going into the hospital for that condition, adjusted for how sick they were. PSI-90 combines several serious complications (a lower number is better). “No different from the national rate” is the most common result and means the hospital is in line with hospitals nationwide.
Deaths within 30 days: heart attack patients Too few cases to report Deaths within 30 days: heart failure patients Too few cases to report Deaths within 30 days: pneumonia patients Too few cases to report Deaths within 30 days: COPD patients Too few cases to report Deaths within 30 days: stroke patients Too few cases to report Deaths within 30 days: coronary bypass surgery (CABG) Not reported to Medicare Serious complications (patient safety indicator PSI-90) Not reported to Medicare Complications after hip or knee replacement Not reported to Medicare
Source: Complications and Deaths - Hospital — CMS, released September 10, 2026.
Return visits to the hospital (readmissions) What this means: The share of patients who had to be admitted to a hospital again within 30 days after going home, adjusted for how sick they were. A lower percentage is better.
Returned to any hospital within 30 days (all patients) Not reported to Medicare Readmitted within 30 days: heart attack Not reported to Medicare Readmitted within 30 days: heart failure Too few cases to report Readmitted within 30 days: pneumonia Too few cases to report Readmitted within 30 days: COPD Too few cases to report Readmitted within 30 days: coronary bypass surgery Not reported to Medicare Readmitted within 30 days: hip or knee replacement Not reported to Medicare
Source: Unplanned Hospital Visits - Hospital — CMS, released September 10, 2026.
Emergency room times and sepsis care What this means: ER time is the middle (median) time from arriving at the emergency room to leaving it; busier ERs usually have longer times, so the ER volume is shown too. Leaving before being seen: a lower percentage is better. Sepsis is a life-threatening reaction to an infection; a higher percentage means more patients got every recommended early step.
Emergency room volume (patients per year) Low (under 20,000) Average (median) time patients spent in the emergency room before leaving (OP-18b) 88 minutes National average: 162 minutes Patients who left the emergency room before being seen (OP-22) 1% National average: 2% Sepsis patients who got all the recommended early care (SEP-1) Not reported to Medicare
Source: Timely and Effective Care - Hospital — CMS, released July 22, 2026; data from January 2024 to December 2024.
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ER wait times and Medicare ratings nearby How this hospital compares with others in the area, ranked only by official Medicare (CMS) numbers.
Prices Every US hospital must publish its standard charges in a file that follows a federal (CMS) format. Below are 71 common services exactly as Iowa Specialty Hospital - Belmond lists them in its file. This is not a quote: what you pay depends on your insurance and plan, the doctors involved and the care you actually receive. Prices change: ask the hospital for an estimate before you schedule care (if you are uninsured or paying yourself, you have the right to a written “good faith estimate”). In a medical emergency, call 911.
What the prices mean Hospital charge The hospital’s list price (“gross charge”) before any discount or insurance. Few people pay this amount. Cash price The price the hospital offers if you pay yourself, without insurance (“discounted cash price”). Insurance rates The lowest and highest amounts the hospital has agreed with any insurance plan for the service (“de-identified minimum and maximum”), and some of the rates it lists by insurer and plan. Your share depends on your deductible, copay and coinsurance. Hospital and doctor fees A service can have a hospital (facility) fee and a separate doctor (professional) fee; the total for your care can include both, plus other services. How to use hospital prices: estimates, financial assistance and your rights →
Office and emergency visits Service Hospital charge Cash price Insurance rates (lowest – highest) New patient office visit (about 30–44 minutes) CPT 99203 · Outpatient (no overnight stay) In the file: New patient office or other outpatient visit with low level of medical decision making, if using time, 30 minutes or more $228 $136.80 $72.96 – $221.16 New patient office visit (about 30–44 minutes): 10 of 15 insurance plan rates AETNA/COVENTRY HMO — AETNA/COVENTRY HMO : $212.04 AETNA/COVENTRY MCR ADV — AETNA/COVENTRY MCR ADV : $72.96 AETNA/COVENTRY PPO-ALL OTHER PLANS — AETNA/COVENTRY PPO-ALL OTHER PLANS : $216.60 AUXIANT CLARION SCHOOLS-ALL PLANS — AUXIANT CLARION SCHOOLS-ALL PLANS : $148.20 CIGNA-ALL PLANS — CIGNA-ALL PLANS : $221.16 HEALTH PARTNERS ISH-ALL OTHER PLANS — HEALTH PARTNERS ISH-ALL OTHER PLANS : $182.40 HEALTH PARTNERS PRESTAGE — HEALTH PARTNERS PRESTAGE : $171 HEALTHSCOPE STELLAR - ALL PLANS — HEALTHSCOPE STELLAR - ALL PLANS : $120.38 MIDLANDS CHOICE-ALL PLANS — MIDLANDS CHOICE-ALL PLANS : $221.16 TRICARE-ALL PLANS — TRICARE-ALL PLANS : $72.96 New patient office visit (about 45–59 minutes) CPT 99204 · Outpatient (no overnight stay) In the file: New patient office or other outpatient visit with moderate level of medical decision making, if using time, 45 minutes or more $339 $203.40 $108.48 – $328.83 New patient office visit (about 45–59 minutes): 10 of 15 insurance plan rates AETNA/COVENTRY HMO — AETNA/COVENTRY HMO : $315.27 AETNA/COVENTRY MCR ADV — AETNA/COVENTRY MCR ADV : $108.48 AETNA/COVENTRY PPO-ALL OTHER PLANS — AETNA/COVENTRY PPO-ALL OTHER PLANS : $322.05 AUXIANT CLARION SCHOOLS-ALL PLANS — AUXIANT CLARION SCHOOLS-ALL PLANS : $220.35 CIGNA-ALL PLANS — CIGNA-ALL PLANS : $328.83 HEALTH PARTNERS ISH-ALL OTHER PLANS — HEALTH PARTNERS ISH-ALL OTHER PLANS : $271.20 HEALTH PARTNERS PRESTAGE — HEALTH PARTNERS PRESTAGE : $254.25 HEALTHSCOPE STELLAR - ALL PLANS — HEALTHSCOPE STELLAR - ALL PLANS : $178.99 MIDLANDS CHOICE-ALL PLANS — MIDLANDS CHOICE-ALL PLANS : $328.83 TRICARE-ALL PLANS — TRICARE-ALL PLANS : $108.48 New patient office visit (about 60–74 minutes) CPT 99205 · Outpatient (no overnight stay) In the file: New patient office or other outpatient visit with a high level of medical decision making, if using time, 60 minutes or more $447 $268.20 $143.04 – $433.59 New patient office visit (about 60–74 minutes): 10 of 15 insurance plan rates AETNA/COVENTRY HMO — AETNA/COVENTRY HMO : $415.71 AETNA/COVENTRY MCR ADV — AETNA/COVENTRY MCR ADV : $143.04 AETNA/COVENTRY PPO-ALL OTHER PLANS — AETNA/COVENTRY PPO-ALL OTHER PLANS : $424.65 AUXIANT CLARION SCHOOLS-ALL PLANS — AUXIANT CLARION SCHOOLS-ALL PLANS : $290.55 CIGNA-ALL PLANS — CIGNA-ALL PLANS : $433.59 HEALTH PARTNERS ISH-ALL OTHER PLANS — HEALTH PARTNERS ISH-ALL OTHER PLANS : $357.60 HEALTH PARTNERS PRESTAGE — HEALTH PARTNERS PRESTAGE : $335.25 HEALTHSCOPE STELLAR - ALL PLANS — HEALTHSCOPE STELLAR - ALL PLANS : $236.02 MIDLANDS CHOICE-ALL PLANS — MIDLANDS CHOICE-ALL PLANS : $433.59 TRICARE-ALL PLANS — TRICARE-ALL PLANS : $143.04 Established patient office visit (about 20–29 minutes) CPT 99213 · Outpatient (no overnight stay) In the file: Established patient office or other outpatient visit with low level of decision making, if using time, 20 minutes or more $182 $109.20 $58.24 – $176.54 Established patient office visit (about 20–29 minutes): 10 of 15 insurance plan rates AETNA/COVENTRY HMO — AETNA/COVENTRY HMO : $169.26 AETNA/COVENTRY MCR ADV — AETNA/COVENTRY MCR ADV : $58.24 AETNA/COVENTRY PPO-ALL OTHER PLANS — AETNA/COVENTRY PPO-ALL OTHER PLANS : $172.90 AUXIANT CLARION SCHOOLS-ALL PLANS — AUXIANT CLARION SCHOOLS-ALL PLANS : $118.30 CIGNA-ALL PLANS — CIGNA-ALL PLANS : $176.54 HEALTH PARTNERS ISH-ALL OTHER PLANS — HEALTH PARTNERS ISH-ALL OTHER PLANS : $145.60 HEALTH PARTNERS PRESTAGE — HEALTH PARTNERS PRESTAGE : $136.50 HEALTHSCOPE STELLAR - ALL PLANS — HEALTHSCOPE STELLAR - ALL PLANS : $96.10 MIDLANDS CHOICE-ALL PLANS — MIDLANDS CHOICE-ALL PLANS : $176.54 TRICARE-ALL PLANS — TRICARE-ALL PLANS : $58.24 Established patient office visit (about 30–39 minutes) CPT 99214 · Outpatient (no overnight stay) In the file: Established patient office or other outpatient visit with moderate level of decision making, if using time, 30 minutes or more $260 $156 $83.20 – $252.20 Established patient office visit (about 30–39 minutes): 10 of 15 insurance plan rates AETNA/COVENTRY HMO — AETNA/COVENTRY HMO : $241.80 AETNA/COVENTRY MCR ADV — AETNA/COVENTRY MCR ADV : $83.20 AETNA/COVENTRY PPO-ALL OTHER PLANS — AETNA/COVENTRY PPO-ALL OTHER PLANS : $247 AUXIANT CLARION SCHOOLS-ALL PLANS — AUXIANT CLARION SCHOOLS-ALL PLANS : $169 CIGNA-ALL PLANS — CIGNA-ALL PLANS : $252.20 HEALTH PARTNERS ISH-ALL OTHER PLANS — HEALTH PARTNERS ISH-ALL OTHER PLANS : $208 HEALTH PARTNERS PRESTAGE — HEALTH PARTNERS PRESTAGE : $195 HEALTHSCOPE STELLAR - ALL PLANS — HEALTHSCOPE STELLAR - ALL PLANS : $137.28 MIDLANDS CHOICE-ALL PLANS — MIDLANDS CHOICE-ALL PLANS : $252.20 TRICARE-ALL PLANS — TRICARE-ALL PLANS : $83.20 Office consultation with a specialist (moderate) CPT 99243 · Outpatient (no overnight stay) In the file: Office or other outpatient consultation with low level of medical decision making, if using time, 30 minutes or more $237 $142.20 $93.38 – $177.75 Office consultation with a specialist (moderate): rates for 7 insurance plans AETNA/COVENTRY HMO — AETNA/COVENTRY HMO : $93.38 AETNA/COVENTRY PPO-ALL OTHER PLANS — AETNA/COVENTRY PPO-ALL OTHER PLANS : $93.38 AUXIANT CLARION SCHOOLS-ALL PLANS — AUXIANT CLARION SCHOOLS-ALL PLANS : $154.05 HEALTH PARTNERS PRESTAGE — HEALTH PARTNERS PRESTAGE : $177.75 UHC COMM-ALL OTHER PLANS — UHC COMM-ALL OTHER PLANS : $137.11 WELLMARK HMO — WELLMARK HMO : $151 WELLMARK PPO-ALL OTHER PLANS — WELLMARK PPO-ALL OTHER PLANS : $151 Office consultation with a specialist (moderate to high) CPT 99244 · Outpatient (no overnight stay) In the file: Office or other outpatient consultation with moderate level of medical decision making, if using time, 40 minutes or more $76 $45.60 $49.40 – $243 Office consultation with a specialist (moderate to high): rates for 7 insurance plans AETNA/COVENTRY HMO — AETNA/COVENTRY HMO : $150.13 AETNA/COVENTRY PPO-ALL OTHER PLANS — AETNA/COVENTRY PPO-ALL OTHER PLANS : $150.13 AUXIANT CLARION SCHOOLS-ALL PLANS — AUXIANT CLARION SCHOOLS-ALL PLANS : $49.40 HEALTH PARTNERS PRESTAGE — HEALTH PARTNERS PRESTAGE : $57 UHC COMM-ALL OTHER PLANS — UHC COMM-ALL OTHER PLANS : $220.30 WELLMARK HMO — WELLMARK HMO : $243 WELLMARK PPO-ALL OTHER PLANS — WELLMARK PPO-ALL OTHER PLANS : $243 Preventive checkup, new patient, age 18–39 CPT 99385 · Outpatient (no overnight stay) In the file: Initial new patient preventive medicine evaluation (18-39 years) $295 $177 $95.81 – $221.25 Preventive checkup, new patient, age 18–39: rates for 10 insurance plans AETNA/COVENTRY HMO — AETNA/COVENTRY HMO : $95.81 AETNA/COVENTRY PPO-ALL OTHER PLANS — AETNA/COVENTRY PPO-ALL OTHER PLANS : $95.81 AUXIANT CLARION SCHOOLS-ALL PLANS — AUXIANT CLARION SCHOOLS-ALL PLANS : $191.75 CIGNA-ALL PLANS — CIGNA-ALL PLANS : $128.79 HEALTH PARTNERS ISH-ALL OTHER PLANS — HEALTH PARTNERS ISH-ALL OTHER PLANS : $140.75 HEALTH PARTNERS PRESTAGE — HEALTH PARTNERS PRESTAGE : $221.25 MIDLANDS CHOICE-ALL PLANS — MIDLANDS CHOICE-ALL PLANS : $128.79 UHC COMM-ALL OTHER PLANS — UHC COMM-ALL OTHER PLANS : $125.04 WELLMARK HMO — WELLMARK HMO : $148 WELLMARK PPO-ALL OTHER PLANS — WELLMARK PPO-ALL OTHER PLANS : $148 Preventive checkup, new patient, age 40–64 CPT 99386 · Outpatient (no overnight stay) In the file: Initial new patient preventive medicine evaluation (40-64 years) $340 $204 $116.30 – $255 Preventive checkup, new patient, age 40–64: rates for 10 insurance plans AETNA/COVENTRY HMO — AETNA/COVENTRY HMO : $116.30 AETNA/COVENTRY PPO-ALL OTHER PLANS — AETNA/COVENTRY PPO-ALL OTHER PLANS : $116.30 AUXIANT CLARION SCHOOLS-ALL PLANS — AUXIANT CLARION SCHOOLS-ALL PLANS : $221 CIGNA-ALL PLANS — CIGNA-ALL PLANS : $156.30 HEALTH PARTNERS ISH-ALL OTHER PLANS — HEALTH PARTNERS ISH-ALL OTHER PLANS : $170.39 HEALTH PARTNERS PRESTAGE — HEALTH PARTNERS PRESTAGE : $255 MIDLANDS CHOICE-ALL PLANS — MIDLANDS CHOICE-ALL PLANS : $156.30 UHC COMM-ALL OTHER PLANS — UHC COMM-ALL OTHER PLANS : $152.06 WELLMARK HMO — WELLMARK HMO : $180 WELLMARK PPO-ALL OTHER PLANS — WELLMARK PPO-ALL OTHER PLANS : $180 Emergency room visit (moderate) CPT 99283 · Outpatient (no overnight stay) In the file: Emergency department visit with low level of medical decision making $197 $118.20 $62.73 – $147.75 Emergency room visit (moderate): 10 of 15 insurance plan rates AETNA/COVENTRY HMO — AETNA/COVENTRY HMO : $62.73 AETNA/COVENTRY MCR ADV — AETNA/COVENTRY MCR ADV : $64.65 AETNA/COVENTRY PPO-ALL OTHER PLANS — AETNA/COVENTRY PPO-ALL OTHER PLANS : $62.73 AUXIANT CLARION SCHOOLS-ALL PLANS — AUXIANT CLARION SCHOOLS-ALL PLANS : $128.05 CIGNA-ALL PLANS — CIGNA-ALL PLANS : $98.94 HEALTH PARTNERS ISH-ALL OTHER PLANS — HEALTH PARTNERS ISH-ALL OTHER PLANS : $108.09 HEALTH PARTNERS PRESTAGE — HEALTH PARTNERS PRESTAGE : $147.75 HEALTHSCOPE STELLAR - ALL PLANS — HEALTHSCOPE STELLAR - ALL PLANS : $106.67 MIDLANDS CHOICE-ALL PLANS — MIDLANDS CHOICE-ALL PLANS : $98.94 TRICARE-ALL PLANS — TRICARE-ALL PLANS : $64.65 Emergency room visit (moderate) CPT 99283 · Inpatient or outpatient In the file: Emergency department visit with low level of medical decision making $649 $389.40 $207.68 – $629.53 Emergency room visit (moderate): 10 of 13 insurance plan rates AETNA/COVENTRY HMO — AETNA/COVENTRY HMO : $603.57 AETNA/COVENTRY MCR ADV — AETNA/COVENTRY MCR ADV : $207.68 AETNA/COVENTRY PPO-ALL OTHER PLANS — AETNA/COVENTRY PPO-ALL OTHER PLANS : $616.55 AUXIANT CLARION SCHOOLS-ALL PLANS — AUXIANT CLARION SCHOOLS-ALL PLANS : $421.85 CIGNA-ALL PLANS — CIGNA-ALL PLANS : $629.53 HEALTH PARTNERS ISH-ALL OTHER PLANS — HEALTH PARTNERS ISH-ALL OTHER PLANS : $519.20 HEALTH PARTNERS PRESTAGE — HEALTH PARTNERS PRESTAGE : $486.75 HEALTHSCOPE STELLAR - ALL PLANS — HEALTHSCOPE STELLAR - ALL PLANS : $342.67 MIDLANDS CHOICE-ALL PLANS — MIDLANDS CHOICE-ALL PLANS : $629.53 TRICARE-ALL PLANS — TRICARE-ALL PLANS : $207.68 Emergency room visit (moderately high) CPT 99284 · Outpatient (no overnight stay) In the file: Emergency department visit with moderate level of medical decision making $271 $162.60 $109.91 – $205.79 Emergency room visit (moderately high): 10 of 15 insurance plan rates AETNA/COVENTRY HMO — AETNA/COVENTRY HMO : $114.66 AETNA/COVENTRY MCR ADV — AETNA/COVENTRY MCR ADV : $109.91 AETNA/COVENTRY PPO-ALL OTHER PLANS — AETNA/COVENTRY PPO-ALL OTHER PLANS : $114.66 AUXIANT CLARION SCHOOLS-ALL PLANS — AUXIANT CLARION SCHOOLS-ALL PLANS : $176.15 CIGNA-ALL PLANS — CIGNA-ALL PLANS : $181.75 HEALTH PARTNERS ISH-ALL OTHER PLANS — HEALTH PARTNERS ISH-ALL OTHER PLANS : $205.79 HEALTH PARTNERS PRESTAGE — HEALTH PARTNERS PRESTAGE : $203.25 HEALTHSCOPE STELLAR - ALL PLANS — HEALTHSCOPE STELLAR - ALL PLANS : $181.35 MIDLANDS CHOICE-ALL PLANS — MIDLANDS CHOICE-ALL PLANS : $181.75 TRICARE-ALL PLANS — TRICARE-ALL PLANS : $109.91 Emergency room visit (moderately high) CPT 99284 · Inpatient or outpatient In the file: Emergency department visit with moderate level of medical decision making $805 $483 $257.60 – $780.85 Emergency room visit (moderately high): 10 of 13 insurance plan rates AETNA/COVENTRY HMO — AETNA/COVENTRY HMO : $748.65 AETNA/COVENTRY MCR ADV — AETNA/COVENTRY MCR ADV : $257.60 AETNA/COVENTRY PPO-ALL OTHER PLANS — AETNA/COVENTRY PPO-ALL OTHER PLANS : $764.75 AUXIANT CLARION SCHOOLS-ALL PLANS — AUXIANT CLARION SCHOOLS-ALL PLANS : $523.25 CIGNA-ALL PLANS — CIGNA-ALL PLANS : $780.85 HEALTH PARTNERS ISH-ALL OTHER PLANS — HEALTH PARTNERS ISH-ALL OTHER PLANS : $644 HEALTH PARTNERS PRESTAGE — HEALTH PARTNERS PRESTAGE : $603.75 HEALTHSCOPE STELLAR - ALL PLANS — HEALTHSCOPE STELLAR - ALL PLANS : $425.04 MIDLANDS CHOICE-ALL PLANS — MIDLANDS CHOICE-ALL PLANS : $780.85 TRICARE-ALL PLANS — TRICARE-ALL PLANS : $257.60 Emergency room visit (high) CPT 99285 · Outpatient (no overnight stay) In the file: Emergency department visit with high level of medical decision making $399 $239.40 $159.83 – $301.65 Emergency room visit (high): 10 of 15 insurance plan rates AETNA/COVENTRY HMO — AETNA/COVENTRY HMO : $166.50 AETNA/COVENTRY MCR ADV — AETNA/COVENTRY MCR ADV : $159.83 AETNA/COVENTRY PPO-ALL OTHER PLANS — AETNA/COVENTRY PPO-ALL OTHER PLANS : $166.50 AUXIANT CLARION SCHOOLS-ALL PLANS — AUXIANT CLARION SCHOOLS-ALL PLANS : $259.35 CIGNA-ALL PLANS — CIGNA-ALL PLANS : $264.03 HEALTH PARTNERS ISH-ALL OTHER PLANS — HEALTH PARTNERS ISH-ALL OTHER PLANS : $301.65 HEALTH PARTNERS PRESTAGE — HEALTH PARTNERS PRESTAGE : $299.25 HEALTHSCOPE STELLAR - ALL PLANS — HEALTHSCOPE STELLAR - ALL PLANS : $263.72 MIDLANDS CHOICE-ALL PLANS — MIDLANDS CHOICE-ALL PLANS : $264.03 TRICARE-ALL PLANS — TRICARE-ALL PLANS : $159.83 Emergency room visit (high) CPT 99285 · Inpatient or outpatient In the file: Emergency department visit with high level of medical decision making $1,312 $787.20 $419.84 – $1,272.64 Emergency room visit (high): 10 of 13 insurance plan rates AETNA/COVENTRY HMO — AETNA/COVENTRY HMO : $1,220.16 AETNA/COVENTRY MCR ADV — AETNA/COVENTRY MCR ADV : $419.84 AETNA/COVENTRY PPO-ALL OTHER PLANS — AETNA/COVENTRY PPO-ALL OTHER PLANS : $1,246.40 AUXIANT CLARION SCHOOLS-ALL PLANS — AUXIANT CLARION SCHOOLS-ALL PLANS : $852.80 CIGNA-ALL PLANS — CIGNA-ALL PLANS : $1,272.64 HEALTH PARTNERS ISH-ALL OTHER PLANS — HEALTH PARTNERS ISH-ALL OTHER PLANS : $1,049.60 HEALTH PARTNERS PRESTAGE — HEALTH PARTNERS PRESTAGE : $984 HEALTHSCOPE STELLAR - ALL PLANS — HEALTHSCOPE STELLAR - ALL PLANS : $692.74 MIDLANDS CHOICE-ALL PLANS — MIDLANDS CHOICE-ALL PLANS : $1,272.64 TRICARE-ALL PLANS — TRICARE-ALL PLANS : $419.84
Lab tests Service Hospital charge Cash price Insurance rates (lowest – highest) Basic metabolic panel (blood test) CPT 80048 · Outpatient (no overnight stay) In the file: Blood test, basic group of blood chemicals (Calcium, total) $253 $151.80 $64.24 – $245.41 Basic metabolic panel (blood test): 10 of 15 insurance plan rates AETNA/COVENTRY HMO — AETNA/COVENTRY HMO : $235.29 AETNA/COVENTRY MCR ADV — AETNA/COVENTRY MCR ADV : $80.96 AETNA/COVENTRY PPO-ALL OTHER PLANS — AETNA/COVENTRY PPO-ALL OTHER PLANS : $240.35 AUXIANT CLARION SCHOOLS-ALL PLANS — AUXIANT CLARION SCHOOLS-ALL PLANS : $164.45 CIGNA-ALL PLANS — CIGNA-ALL PLANS : $245.41 HEALTH PARTNERS ISH-ALL OTHER PLANS — HEALTH PARTNERS ISH-ALL OTHER PLANS : $202.40 HEALTH PARTNERS PRESTAGE — HEALTH PARTNERS PRESTAGE : $189.75 HEALTHSCOPE STELLAR - ALL PLANS — HEALTHSCOPE STELLAR - ALL PLANS : $133.58 MIDLANDS CHOICE-ALL PLANS — MIDLANDS CHOICE-ALL PLANS : $245.41 TRICARE-ALL PLANS — TRICARE-ALL PLANS : $80.96 Comprehensive metabolic panel (blood test) CPT 80053 · Outpatient (no overnight stay) In the file: Blood test, comprehensive group of blood chemicals $365 $219 $64.24 – $354.05 Comprehensive metabolic panel (blood test): 10 of 15 insurance plan rates AETNA/COVENTRY HMO — AETNA/COVENTRY HMO : $339.45 AETNA/COVENTRY MCR ADV — AETNA/COVENTRY MCR ADV : $116.80 AETNA/COVENTRY PPO-ALL OTHER PLANS — AETNA/COVENTRY PPO-ALL OTHER PLANS : $346.75 AUXIANT CLARION SCHOOLS-ALL PLANS — AUXIANT CLARION SCHOOLS-ALL PLANS : $237.25 CIGNA-ALL PLANS — CIGNA-ALL PLANS : $354.05 HEALTH PARTNERS ISH-ALL OTHER PLANS — HEALTH PARTNERS ISH-ALL OTHER PLANS : $292 HEALTH PARTNERS PRESTAGE — HEALTH PARTNERS PRESTAGE : $273.75 HEALTHSCOPE STELLAR - ALL PLANS — HEALTHSCOPE STELLAR - ALL PLANS : $192.72 MIDLANDS CHOICE-ALL PLANS — MIDLANDS CHOICE-ALL PLANS : $354.05 TRICARE-ALL PLANS — TRICARE-ALL PLANS : $116.80 Obstetric blood test panel CPT 80055 · Outpatient (no overnight stay) In the file: Obstetric blood test panel $134 $80.40 $42.88 – $129.98 Obstetric blood test panel: 10 of 15 insurance plan rates AETNA/COVENTRY HMO — AETNA/COVENTRY HMO : $124.62 AETNA/COVENTRY MCR ADV — AETNA/COVENTRY MCR ADV : $42.88 AETNA/COVENTRY PPO-ALL OTHER PLANS — AETNA/COVENTRY PPO-ALL OTHER PLANS : $127.30 AUXIANT CLARION SCHOOLS-ALL PLANS — AUXIANT CLARION SCHOOLS-ALL PLANS : $87.10 CIGNA-ALL PLANS — CIGNA-ALL PLANS : $129.98 HEALTH PARTNERS ISH-ALL OTHER PLANS — HEALTH PARTNERS ISH-ALL OTHER PLANS : $107.20 HEALTH PARTNERS PRESTAGE — HEALTH PARTNERS PRESTAGE : $100.50 HEALTHSCOPE STELLAR - ALL PLANS — HEALTHSCOPE STELLAR - ALL PLANS : $70.75 MIDLANDS CHOICE-ALL PLANS — MIDLANDS CHOICE-ALL PLANS : $129.98 TRICARE-ALL PLANS — TRICARE-ALL PLANS : $42.88 Cholesterol panel (lipid panel) CPT 80061 · Outpatient (no overnight stay) In the file: Blood test, lipids (cholesterol and triglycerides) $167 $100.20 $53.44 – $161.99 Cholesterol panel (lipid panel): 10 of 15 insurance plan rates AETNA/COVENTRY HMO — AETNA/COVENTRY HMO : $155.31 AETNA/COVENTRY MCR ADV — AETNA/COVENTRY MCR ADV : $53.44 AETNA/COVENTRY PPO-ALL OTHER PLANS — AETNA/COVENTRY PPO-ALL OTHER PLANS : $158.65 AUXIANT CLARION SCHOOLS-ALL PLANS — AUXIANT CLARION SCHOOLS-ALL PLANS : $108.55 CIGNA-ALL PLANS — CIGNA-ALL PLANS : $161.99 HEALTH PARTNERS ISH-ALL OTHER PLANS — HEALTH PARTNERS ISH-ALL OTHER PLANS : $133.60 HEALTH PARTNERS PRESTAGE — HEALTH PARTNERS PRESTAGE : $125.25 HEALTHSCOPE STELLAR - ALL PLANS — HEALTHSCOPE STELLAR - ALL PLANS : $88.18 MIDLANDS CHOICE-ALL PLANS — MIDLANDS CHOICE-ALL PLANS : $161.99 TRICARE-ALL PLANS — TRICARE-ALL PLANS : $53.44 Kidney function panel CPT 80069 · Outpatient (no overnight stay) In the file: Kidney function blood test panel $45 $27 $14.40 – $70.61 Kidney function panel: 10 of 15 insurance plan rates AETNA/COVENTRY HMO — AETNA/COVENTRY HMO : $41.85 AETNA/COVENTRY MCR ADV — AETNA/COVENTRY MCR ADV : $14.40 AETNA/COVENTRY PPO-ALL OTHER PLANS — AETNA/COVENTRY PPO-ALL OTHER PLANS : $42.75 AUXIANT CLARION SCHOOLS-ALL PLANS — AUXIANT CLARION SCHOOLS-ALL PLANS : $29.25 CIGNA-ALL PLANS — CIGNA-ALL PLANS : $43.65 HEALTH PARTNERS ISH-ALL OTHER PLANS — HEALTH PARTNERS ISH-ALL OTHER PLANS : $36 HEALTH PARTNERS PRESTAGE — HEALTH PARTNERS PRESTAGE : $33.75 HEALTHSCOPE STELLAR - ALL PLANS — HEALTHSCOPE STELLAR - ALL PLANS : $23.76 MIDLANDS CHOICE-ALL PLANS — MIDLANDS CHOICE-ALL PLANS : $43.65 TRICARE-ALL PLANS — TRICARE-ALL PLANS : $14.40 Liver function panel CPT 80076 · Outpatient (no overnight stay) In the file: Liver function blood test panel $194 $116.40 $62.08 – $188.18 Liver function panel: 10 of 15 insurance plan rates AETNA/COVENTRY HMO — AETNA/COVENTRY HMO : $180.42 AETNA/COVENTRY MCR ADV — AETNA/COVENTRY MCR ADV : $62.08 AETNA/COVENTRY PPO-ALL OTHER PLANS — AETNA/COVENTRY PPO-ALL OTHER PLANS : $184.30 AUXIANT CLARION SCHOOLS-ALL PLANS — AUXIANT CLARION SCHOOLS-ALL PLANS : $126.10 CIGNA-ALL PLANS — CIGNA-ALL PLANS : $188.18 HEALTH PARTNERS ISH-ALL OTHER PLANS — HEALTH PARTNERS ISH-ALL OTHER PLANS : $155.20 HEALTH PARTNERS PRESTAGE — HEALTH PARTNERS PRESTAGE : $145.50 HEALTHSCOPE STELLAR - ALL PLANS — HEALTHSCOPE STELLAR - ALL PLANS : $102.43 MIDLANDS CHOICE-ALL PLANS — MIDLANDS CHOICE-ALL PLANS : $188.18 TRICARE-ALL PLANS — TRICARE-ALL PLANS : $62.08 Urine test (automated, with microscope) CPT 81001 · Outpatient (no overnight stay) In the file: Manual urinalysis test with examination using microscope, automated $89 $53.40 $26.89 – $86.33 Urine test (automated, with microscope): 10 of 15 insurance plan rates AETNA/COVENTRY HMO — AETNA/COVENTRY HMO : $82.77 AETNA/COVENTRY MCR ADV — AETNA/COVENTRY MCR ADV : $28.48 AETNA/COVENTRY PPO-ALL OTHER PLANS — AETNA/COVENTRY PPO-ALL OTHER PLANS : $84.55 AUXIANT CLARION SCHOOLS-ALL PLANS — AUXIANT CLARION SCHOOLS-ALL PLANS : $57.85 CIGNA-ALL PLANS — CIGNA-ALL PLANS : $86.33 HEALTH PARTNERS ISH-ALL OTHER PLANS — HEALTH PARTNERS ISH-ALL OTHER PLANS : $71.20 HEALTH PARTNERS PRESTAGE — HEALTH PARTNERS PRESTAGE : $66.75 HEALTHSCOPE STELLAR - ALL PLANS — HEALTHSCOPE STELLAR - ALL PLANS : $46.99 MIDLANDS CHOICE-ALL PLANS — MIDLANDS CHOICE-ALL PLANS : $86.33 TRICARE-ALL PLANS — TRICARE-ALL PLANS : $28.48 Urine test (manual, without microscope) CPT 81002 · Outpatient (no overnight stay) In the file: Urinalysis, manual test $59 $35.40 $18.88 – $57.23 Urine test (manual, without microscope): 10 of 15 insurance plan rates AETNA/COVENTRY HMO — AETNA/COVENTRY HMO : $54.87 AETNA/COVENTRY MCR ADV — AETNA/COVENTRY MCR ADV : $18.88 AETNA/COVENTRY PPO-ALL OTHER PLANS — AETNA/COVENTRY PPO-ALL OTHER PLANS : $56.05 AUXIANT CLARION SCHOOLS-ALL PLANS — AUXIANT CLARION SCHOOLS-ALL PLANS : $38.35 CIGNA-ALL PLANS — CIGNA-ALL PLANS : $57.23 HEALTH PARTNERS ISH-ALL OTHER PLANS — HEALTH PARTNERS ISH-ALL OTHER PLANS : $47.20 HEALTH PARTNERS PRESTAGE — HEALTH PARTNERS PRESTAGE : $44.25 HEALTHSCOPE STELLAR - ALL PLANS — HEALTHSCOPE STELLAR - ALL PLANS : $31.15 MIDLANDS CHOICE-ALL PLANS — MIDLANDS CHOICE-ALL PLANS : $57.23 TRICARE-ALL PLANS — TRICARE-ALL PLANS : $18.88 Urine test (automated, without microscope) CPT 81003 · Outpatient (no overnight stay) In the file: Automated urinalysis test $60 $36 $19.20 – $58.20 Urine test (automated, without microscope): 10 of 15 insurance plan rates AETNA/COVENTRY HMO — AETNA/COVENTRY HMO : $55.80 AETNA/COVENTRY MCR ADV — AETNA/COVENTRY MCR ADV : $19.20 AETNA/COVENTRY PPO-ALL OTHER PLANS — AETNA/COVENTRY PPO-ALL OTHER PLANS : $57 AUXIANT CLARION SCHOOLS-ALL PLANS — AUXIANT CLARION SCHOOLS-ALL PLANS : $39 CIGNA-ALL PLANS — CIGNA-ALL PLANS : $58.20 HEALTH PARTNERS ISH-ALL OTHER PLANS — HEALTH PARTNERS ISH-ALL OTHER PLANS : $48 HEALTH PARTNERS PRESTAGE — HEALTH PARTNERS PRESTAGE : $45 HEALTHSCOPE STELLAR - ALL PLANS — HEALTHSCOPE STELLAR - ALL PLANS : $31.68 MIDLANDS CHOICE-ALL PLANS — MIDLANDS CHOICE-ALL PLANS : $58.20 TRICARE-ALL PLANS — TRICARE-ALL PLANS : $19.20 PSA (prostate specific antigen) blood test CPT 84153 · Outpatient (no overnight stay) In the file: PSA (prostate specific antigen) measurement, total $222 $133.20 $64.99 – $215.34 PSA (prostate specific antigen) blood test: 10 of 15 insurance plan rates AETNA/COVENTRY HMO — AETNA/COVENTRY HMO : $206.46 AETNA/COVENTRY MCR ADV — AETNA/COVENTRY MCR ADV : $71.04 AETNA/COVENTRY PPO-ALL OTHER PLANS — AETNA/COVENTRY PPO-ALL OTHER PLANS : $210.90 AUXIANT CLARION SCHOOLS-ALL PLANS — AUXIANT CLARION SCHOOLS-ALL PLANS : $144.30 CIGNA-ALL PLANS — CIGNA-ALL PLANS : $215.34 HEALTH PARTNERS ISH-ALL OTHER PLANS — HEALTH PARTNERS ISH-ALL OTHER PLANS : $177.60 HEALTH PARTNERS PRESTAGE — HEALTH PARTNERS PRESTAGE : $166.50 HEALTHSCOPE STELLAR - ALL PLANS — HEALTHSCOPE STELLAR - ALL PLANS : $117.22 MIDLANDS CHOICE-ALL PLANS — MIDLANDS CHOICE-ALL PLANS : $215.34 TRICARE-ALL PLANS — TRICARE-ALL PLANS : $71.04 Thyroid stimulating hormone (TSH) test CPT 84443 · Outpatient (no overnight stay) In the file: Blood test, thyroid stimulating hormone (TSH) $172 $103.20 $52.29 – $166.84 Thyroid stimulating hormone (TSH) test: 10 of 15 insurance plan rates AETNA/COVENTRY HMO — AETNA/COVENTRY HMO : $159.96 AETNA/COVENTRY MCR ADV — AETNA/COVENTRY MCR ADV : $55.04 AETNA/COVENTRY PPO-ALL OTHER PLANS — AETNA/COVENTRY PPO-ALL OTHER PLANS : $163.40 AUXIANT CLARION SCHOOLS-ALL PLANS — AUXIANT CLARION SCHOOLS-ALL PLANS : $111.80 CIGNA-ALL PLANS — CIGNA-ALL PLANS : $166.84 HEALTH PARTNERS ISH-ALL OTHER PLANS — HEALTH PARTNERS ISH-ALL OTHER PLANS : $137.60 HEALTH PARTNERS PRESTAGE — HEALTH PARTNERS PRESTAGE : $129 HEALTHSCOPE STELLAR - ALL PLANS — HEALTHSCOPE STELLAR - ALL PLANS : $90.82 MIDLANDS CHOICE-ALL PLANS — MIDLANDS CHOICE-ALL PLANS : $166.84 TRICARE-ALL PLANS — TRICARE-ALL PLANS : $55.04 Complete blood count (CBC) with differential CPT 85025 · Outpatient (no overnight stay) In the file: Complete blood cell count (red cells, white blood cell, platelets), automated test and automated differential white blood cell count $157 $94.20 $30.63 – $152.29 Complete blood count (CBC) with differential: 10 of 15 insurance plan rates AETNA/COVENTRY HMO — AETNA/COVENTRY HMO : $146.01 AETNA/COVENTRY MCR ADV — AETNA/COVENTRY MCR ADV : $50.24 AETNA/COVENTRY PPO-ALL OTHER PLANS — AETNA/COVENTRY PPO-ALL OTHER PLANS : $149.15 AUXIANT CLARION SCHOOLS-ALL PLANS — AUXIANT CLARION SCHOOLS-ALL PLANS : $102.05 CIGNA-ALL PLANS — CIGNA-ALL PLANS : $152.29 HEALTH PARTNERS ISH-ALL OTHER PLANS — HEALTH PARTNERS ISH-ALL OTHER PLANS : $125.60 HEALTH PARTNERS PRESTAGE — HEALTH PARTNERS PRESTAGE : $117.75 HEALTHSCOPE STELLAR - ALL PLANS — HEALTHSCOPE STELLAR - ALL PLANS : $82.90 MIDLANDS CHOICE-ALL PLANS — MIDLANDS CHOICE-ALL PLANS : $152.29 TRICARE-ALL PLANS — TRICARE-ALL PLANS : $50.24 Complete blood count (CBC), automated CPT 85027 · Outpatient (no overnight stay) In the file: Complete blood cell count (red cells, white blood cell, platelets), automated test $100 $60 $30.63 – $97 Complete blood count (CBC), automated: 10 of 15 insurance plan rates AETNA/COVENTRY HMO — AETNA/COVENTRY HMO : $93 AETNA/COVENTRY MCR ADV — AETNA/COVENTRY MCR ADV : $32 AETNA/COVENTRY PPO-ALL OTHER PLANS — AETNA/COVENTRY PPO-ALL OTHER PLANS : $95 AUXIANT CLARION SCHOOLS-ALL PLANS — AUXIANT CLARION SCHOOLS-ALL PLANS : $65 CIGNA-ALL PLANS — CIGNA-ALL PLANS : $97 HEALTH PARTNERS ISH-ALL OTHER PLANS — HEALTH PARTNERS ISH-ALL OTHER PLANS : $80 HEALTH PARTNERS PRESTAGE — HEALTH PARTNERS PRESTAGE : $75 HEALTHSCOPE STELLAR - ALL PLANS — HEALTHSCOPE STELLAR - ALL PLANS : $52.80 MIDLANDS CHOICE-ALL PLANS — MIDLANDS CHOICE-ALL PLANS : $97 TRICARE-ALL PLANS — TRICARE-ALL PLANS : $32 Blood clotting time test (prothrombin time, PT) CPT 85610 · Outpatient (no overnight stay) In the file: Blood test, clotting time $6 $3.60 $1.92 – $33.66 Blood clotting time test (prothrombin time, PT): 10 of 15 insurance plan rates AETNA/COVENTRY HMO — AETNA/COVENTRY HMO : $5.58 AETNA/COVENTRY MCR ADV — AETNA/COVENTRY MCR ADV : $1.92 AETNA/COVENTRY PPO-ALL OTHER PLANS — AETNA/COVENTRY PPO-ALL OTHER PLANS : $5.70 AUXIANT CLARION SCHOOLS-ALL PLANS — AUXIANT CLARION SCHOOLS-ALL PLANS : $3.90 CIGNA-ALL PLANS — CIGNA-ALL PLANS : $5.82 HEALTH PARTNERS ISH-ALL OTHER PLANS — HEALTH PARTNERS ISH-ALL OTHER PLANS : $4.80 HEALTH PARTNERS PRESTAGE — HEALTH PARTNERS PRESTAGE : $4.50 HEALTHSCOPE STELLAR - ALL PLANS — HEALTHSCOPE STELLAR - ALL PLANS : $3.17 MIDLANDS CHOICE-ALL PLANS — MIDLANDS CHOICE-ALL PLANS : $5.82 TRICARE-ALL PLANS — TRICARE-ALL PLANS : $1.92 Blood clotting test (partial thromboplastin time, PTT) CPT 85730 · Outpatient (no overnight stay) In the file: Coagulation assessment blood test, plasma or whole blood $81 $48.60 $25.92 – $78.57 Blood clotting test (partial thromboplastin time, PTT): 10 of 15 insurance plan rates AETNA/COVENTRY HMO — AETNA/COVENTRY HMO : $75.33 AETNA/COVENTRY MCR ADV — AETNA/COVENTRY MCR ADV : $25.92 AETNA/COVENTRY PPO-ALL OTHER PLANS — AETNA/COVENTRY PPO-ALL OTHER PLANS : $76.95 AUXIANT CLARION SCHOOLS-ALL PLANS — AUXIANT CLARION SCHOOLS-ALL PLANS : $52.65 CIGNA-ALL PLANS — CIGNA-ALL PLANS : $78.57 HEALTH PARTNERS ISH-ALL OTHER PLANS — HEALTH PARTNERS ISH-ALL OTHER PLANS : $64.80 HEALTH PARTNERS PRESTAGE — HEALTH PARTNERS PRESTAGE : $60.75 HEALTHSCOPE STELLAR - ALL PLANS — HEALTHSCOPE STELLAR - ALL PLANS : $42.77 MIDLANDS CHOICE-ALL PLANS — MIDLANDS CHOICE-ALL PLANS : $78.57 TRICARE-ALL PLANS — TRICARE-ALL PLANS : $25.92
Imaging (X-ray, CT, MRI, ultrasound, mammogram) Service Hospital charge Cash price Insurance rates (lowest – highest) CT scan of the head or brain, without contrast CPT 70450 · Outpatient (no overnight stay) In the file: CT scan head or brain without contrast $1,899 $1,139.40 $607.68 – $1,842.03 CT scan of the head or brain, without contrast: 10 of 15 insurance plan rates AETNA/COVENTRY HMO — AETNA/COVENTRY HMO : $1,766.07 AETNA/COVENTRY MCR ADV — AETNA/COVENTRY MCR ADV : $607.68 AETNA/COVENTRY PPO-ALL OTHER PLANS — AETNA/COVENTRY PPO-ALL OTHER PLANS : $1,804.05 AUXIANT CLARION SCHOOLS-ALL PLANS — AUXIANT CLARION SCHOOLS-ALL PLANS : $1,234.35 CIGNA-ALL PLANS — CIGNA-ALL PLANS : $1,842.03 HEALTH PARTNERS ISH-ALL OTHER PLANS — HEALTH PARTNERS ISH-ALL OTHER PLANS : $1,519.20 HEALTH PARTNERS PRESTAGE — HEALTH PARTNERS PRESTAGE : $1,424.25 HEALTHSCOPE STELLAR - ALL PLANS — HEALTHSCOPE STELLAR - ALL PLANS : $1,002.67 MIDLANDS CHOICE-ALL PLANS — MIDLANDS CHOICE-ALL PLANS : $1,842.03 TRICARE-ALL PLANS — TRICARE-ALL PLANS : $607.68 MRI of the brain, before and after contrast CPT 70553 · Outpatient (no overnight stay) In the file: MRI scan of brain before and after contrast $6,005 $3,603 $1,067.46 – $5,824.85 MRI of the brain, before and after contrast: 10 of 15 insurance plan rates AETNA/COVENTRY HMO — AETNA/COVENTRY HMO : $5,584.65 AETNA/COVENTRY MCR ADV — AETNA/COVENTRY MCR ADV : $1,921.60 AETNA/COVENTRY PPO-ALL OTHER PLANS — AETNA/COVENTRY PPO-ALL OTHER PLANS : $5,704.75 AUXIANT CLARION SCHOOLS-ALL PLANS — AUXIANT CLARION SCHOOLS-ALL PLANS : $3,903.25 CIGNA-ALL PLANS — CIGNA-ALL PLANS : $5,824.85 HEALTH PARTNERS ISH-ALL OTHER PLANS — HEALTH PARTNERS ISH-ALL OTHER PLANS : $4,804 HEALTH PARTNERS PRESTAGE — HEALTH PARTNERS PRESTAGE : $4,503.75 HEALTHSCOPE STELLAR - ALL PLANS — HEALTHSCOPE STELLAR - ALL PLANS : $3,170.64 MIDLANDS CHOICE-ALL PLANS — MIDLANDS CHOICE-ALL PLANS : $5,824.85 TRICARE-ALL PLANS — TRICARE-ALL PLANS : $1,921.60 Chest X-ray, 2 views CPT 71046 · Outpatient (no overnight stay) In the file: X-ray of chest, 2 views $323 $193.80 $103.36 – $313.31 Chest X-ray, 2 views: 10 of 15 insurance plan rates AETNA/COVENTRY HMO — AETNA/COVENTRY HMO : $300.39 AETNA/COVENTRY MCR ADV — AETNA/COVENTRY MCR ADV : $103.36 AETNA/COVENTRY PPO-ALL OTHER PLANS — AETNA/COVENTRY PPO-ALL OTHER PLANS : $306.85 AUXIANT CLARION SCHOOLS-ALL PLANS — AUXIANT CLARION SCHOOLS-ALL PLANS : $209.95 CIGNA-ALL PLANS — CIGNA-ALL PLANS : $313.31 HEALTH PARTNERS ISH-ALL OTHER PLANS — HEALTH PARTNERS ISH-ALL OTHER PLANS : $258.40 HEALTH PARTNERS PRESTAGE — HEALTH PARTNERS PRESTAGE : $242.25 HEALTHSCOPE STELLAR - ALL PLANS — HEALTHSCOPE STELLAR - ALL PLANS : $170.54 MIDLANDS CHOICE-ALL PLANS — MIDLANDS CHOICE-ALL PLANS : $313.31 TRICARE-ALL PLANS — TRICARE-ALL PLANS : $103.36 X-ray of the lower spine, at least 4 views CPT 72110 · Outpatient (no overnight stay) In the file: X-ray of lower and sacral spine, minimum of 4 views $484 $290.40 $109.06 – $469.48 X-ray of the lower spine, at least 4 views: 10 of 15 insurance plan rates AETNA/COVENTRY HMO — AETNA/COVENTRY HMO : $450.12 AETNA/COVENTRY MCR ADV — AETNA/COVENTRY MCR ADV : $154.88 AETNA/COVENTRY PPO-ALL OTHER PLANS — AETNA/COVENTRY PPO-ALL OTHER PLANS : $459.80 AUXIANT CLARION SCHOOLS-ALL PLANS — AUXIANT CLARION SCHOOLS-ALL PLANS : $314.60 CIGNA-ALL PLANS — CIGNA-ALL PLANS : $469.48 HEALTH PARTNERS ISH-ALL OTHER PLANS — HEALTH PARTNERS ISH-ALL OTHER PLANS : $387.20 HEALTH PARTNERS PRESTAGE — HEALTH PARTNERS PRESTAGE : $363 HEALTHSCOPE STELLAR - ALL PLANS — HEALTHSCOPE STELLAR - ALL PLANS : $255.55 MIDLANDS CHOICE-ALL PLANS — MIDLANDS CHOICE-ALL PLANS : $469.48 TRICARE-ALL PLANS — TRICARE-ALL PLANS : $154.88 MRI of the lower back (lumbar spine), without contrast CPT 72148 · Outpatient (no overnight stay) In the file: MRI scan of lower spinal canal without contrast $4,260 $2,556 $763.43 – $4,132.20 MRI of the lower back (lumbar spine), without contrast: 10 of 15 insurance plan rates AETNA/COVENTRY HMO — AETNA/COVENTRY HMO : $3,961.80 AETNA/COVENTRY MCR ADV — AETNA/COVENTRY MCR ADV : $1,363.20 AETNA/COVENTRY PPO-ALL OTHER PLANS — AETNA/COVENTRY PPO-ALL OTHER PLANS : $4,047 AUXIANT CLARION SCHOOLS-ALL PLANS — AUXIANT CLARION SCHOOLS-ALL PLANS : $2,769 CIGNA-ALL PLANS — CIGNA-ALL PLANS : $4,132.20 HEALTH PARTNERS ISH-ALL OTHER PLANS — HEALTH PARTNERS ISH-ALL OTHER PLANS : $3,408 HEALTH PARTNERS PRESTAGE — HEALTH PARTNERS PRESTAGE : $3,195 HEALTHSCOPE STELLAR - ALL PLANS — HEALTHSCOPE STELLAR - ALL PLANS : $2,249.28 MIDLANDS CHOICE-ALL PLANS — MIDLANDS CHOICE-ALL PLANS : $4,132.20 TRICARE-ALL PLANS — TRICARE-ALL PLANS : $1,363.20 CT scan of the pelvis, with contrast CPT 72193 · Outpatient (no overnight stay) In the file: CT scan of pelvis with contrast $2,307 $1,384.20 $738.24 – $2,237.79 CT scan of the pelvis, with contrast: 10 of 15 insurance plan rates AETNA/COVENTRY HMO — AETNA/COVENTRY HMO : $2,145.51 AETNA/COVENTRY MCR ADV — AETNA/COVENTRY MCR ADV : $738.24 AETNA/COVENTRY PPO-ALL OTHER PLANS — AETNA/COVENTRY PPO-ALL OTHER PLANS : $2,191.65 AUXIANT CLARION SCHOOLS-ALL PLANS — AUXIANT CLARION SCHOOLS-ALL PLANS : $1,499.55 CIGNA-ALL PLANS — CIGNA-ALL PLANS : $2,237.79 HEALTH PARTNERS ISH-ALL OTHER PLANS — HEALTH PARTNERS ISH-ALL OTHER PLANS : $1,845.60 HEALTH PARTNERS PRESTAGE — HEALTH PARTNERS PRESTAGE : $1,730.25 HEALTHSCOPE STELLAR - ALL PLANS — HEALTHSCOPE STELLAR - ALL PLANS : $1,218.10 MIDLANDS CHOICE-ALL PLANS — MIDLANDS CHOICE-ALL PLANS : $2,237.79 TRICARE-ALL PLANS — TRICARE-ALL PLANS : $738.24 MRI of a leg joint (such as the knee), without contrast CPT 73721 · Outpatient (no overnight stay) In the file: MRI scan of leg joint without contrast $4,160 $2,496 $763.43 – $4,035.20 MRI of a leg joint (such as the knee), without contrast: 10 of 15 insurance plan rates AETNA/COVENTRY HMO — AETNA/COVENTRY HMO : $3,868.80 AETNA/COVENTRY MCR ADV — AETNA/COVENTRY MCR ADV : $1,331.20 AETNA/COVENTRY PPO-ALL OTHER PLANS — AETNA/COVENTRY PPO-ALL OTHER PLANS : $3,952 AUXIANT CLARION SCHOOLS-ALL PLANS — AUXIANT CLARION SCHOOLS-ALL PLANS : $2,704 CIGNA-ALL PLANS — CIGNA-ALL PLANS : $4,035.20 HEALTH PARTNERS ISH-ALL OTHER PLANS — HEALTH PARTNERS ISH-ALL OTHER PLANS : $3,328 HEALTH PARTNERS PRESTAGE — HEALTH PARTNERS PRESTAGE : $3,120 HEALTHSCOPE STELLAR - ALL PLANS — HEALTHSCOPE STELLAR - ALL PLANS : $2,196.48 MIDLANDS CHOICE-ALL PLANS — MIDLANDS CHOICE-ALL PLANS : $4,035.20 TRICARE-ALL PLANS — TRICARE-ALL PLANS : $1,331.20 CT scan of the abdomen and pelvis, with contrast CPT 74177 · Outpatient (no overnight stay) In the file: CT scan of abdomen and pelvis with contrast $4,930 $2,958 $876.98 – $4,782.10 CT scan of the abdomen and pelvis, with contrast: 10 of 15 insurance plan rates AETNA/COVENTRY HMO — AETNA/COVENTRY HMO : $4,584.90 AETNA/COVENTRY MCR ADV — AETNA/COVENTRY MCR ADV : $1,577.60 AETNA/COVENTRY PPO-ALL OTHER PLANS — AETNA/COVENTRY PPO-ALL OTHER PLANS : $4,683.50 AUXIANT CLARION SCHOOLS-ALL PLANS — AUXIANT CLARION SCHOOLS-ALL PLANS : $3,204.50 CIGNA-ALL PLANS — CIGNA-ALL PLANS : $4,782.10 HEALTH PARTNERS ISH-ALL OTHER PLANS — HEALTH PARTNERS ISH-ALL OTHER PLANS : $3,944 HEALTH PARTNERS PRESTAGE — HEALTH PARTNERS PRESTAGE : $3,697.50 HEALTHSCOPE STELLAR - ALL PLANS — HEALTHSCOPE STELLAR - ALL PLANS : $2,603.04 MIDLANDS CHOICE-ALL PLANS — MIDLANDS CHOICE-ALL PLANS : $4,782.10 TRICARE-ALL PLANS — TRICARE-ALL PLANS : $1,577.60 Ultrasound of the abdomen, complete CPT 76700 · Outpatient (no overnight stay) In the file: Complete ultrasound scan of abdomen $962 $577.20 $307.84 – $933.14 Ultrasound of the abdomen, complete: 10 of 15 insurance plan rates AETNA/COVENTRY HMO — AETNA/COVENTRY HMO : $894.66 AETNA/COVENTRY MCR ADV — AETNA/COVENTRY MCR ADV : $307.84 AETNA/COVENTRY PPO-ALL OTHER PLANS — AETNA/COVENTRY PPO-ALL OTHER PLANS : $913.90 AUXIANT CLARION SCHOOLS-ALL PLANS — AUXIANT CLARION SCHOOLS-ALL PLANS : $625.30 CIGNA-ALL PLANS — CIGNA-ALL PLANS : $933.14 HEALTH PARTNERS ISH-ALL OTHER PLANS — HEALTH PARTNERS ISH-ALL OTHER PLANS : $769.60 HEALTH PARTNERS PRESTAGE — HEALTH PARTNERS PRESTAGE : $721.50 HEALTHSCOPE STELLAR - ALL PLANS — HEALTHSCOPE STELLAR - ALL PLANS : $507.94 MIDLANDS CHOICE-ALL PLANS — MIDLANDS CHOICE-ALL PLANS : $933.14 TRICARE-ALL PLANS — TRICARE-ALL PLANS : $307.84 Pregnancy ultrasound (after the first trimester) CPT 76805 · Outpatient (no overnight stay) In the file: Ultrasound scan of pregnant uterus (14 weeks or more), single or first fetus $556 $333.60 $177.92 – $539.32 Pregnancy ultrasound (after the first trimester): 10 of 15 insurance plan rates AETNA/COVENTRY HMO — AETNA/COVENTRY HMO : $517.08 AETNA/COVENTRY MCR ADV — AETNA/COVENTRY MCR ADV : $177.92 AETNA/COVENTRY PPO-ALL OTHER PLANS — AETNA/COVENTRY PPO-ALL OTHER PLANS : $528.20 AUXIANT CLARION SCHOOLS-ALL PLANS — AUXIANT CLARION SCHOOLS-ALL PLANS : $361.40 CIGNA-ALL PLANS — CIGNA-ALL PLANS : $539.32 HEALTH PARTNERS ISH-ALL OTHER PLANS — HEALTH PARTNERS ISH-ALL OTHER PLANS : $444.80 HEALTH PARTNERS PRESTAGE — HEALTH PARTNERS PRESTAGE : $417 HEALTHSCOPE STELLAR - ALL PLANS — HEALTHSCOPE STELLAR - ALL PLANS : $293.57 MIDLANDS CHOICE-ALL PLANS — MIDLANDS CHOICE-ALL PLANS : $539.32 TRICARE-ALL PLANS — TRICARE-ALL PLANS : $177.92 Transvaginal ultrasound CPT 76830 · Outpatient (no overnight stay) In the file: Ultrasound scan of uterus, ovaries, tubes, cervix and pelvic area through vagina $639 $383.40 $204.48 – $619.83 Transvaginal ultrasound: 10 of 15 insurance plan rates AETNA/COVENTRY HMO — AETNA/COVENTRY HMO : $594.27 AETNA/COVENTRY MCR ADV — AETNA/COVENTRY MCR ADV : $204.48 AETNA/COVENTRY PPO-ALL OTHER PLANS — AETNA/COVENTRY PPO-ALL OTHER PLANS : $607.05 AUXIANT CLARION SCHOOLS-ALL PLANS — AUXIANT CLARION SCHOOLS-ALL PLANS : $415.35 CIGNA-ALL PLANS — CIGNA-ALL PLANS : $619.83 HEALTH PARTNERS ISH-ALL OTHER PLANS — HEALTH PARTNERS ISH-ALL OTHER PLANS : $511.20 HEALTH PARTNERS PRESTAGE — HEALTH PARTNERS PRESTAGE : $479.25 HEALTHSCOPE STELLAR - ALL PLANS — HEALTHSCOPE STELLAR - ALL PLANS : $337.39 MIDLANDS CHOICE-ALL PLANS — MIDLANDS CHOICE-ALL PLANS : $619.83 TRICARE-ALL PLANS — TRICARE-ALL PLANS : $204.48 Diagnostic mammogram, one breast CPT 77065 · Outpatient (no overnight stay) In the file: Diagnostic mammography of 1 breast $552 $331.20 $176.64 – $535.44 Diagnostic mammogram, one breast: 10 of 15 insurance plan rates AETNA/COVENTRY HMO — AETNA/COVENTRY HMO : $513.36 AETNA/COVENTRY MCR ADV — AETNA/COVENTRY MCR ADV : $176.64 AETNA/COVENTRY PPO-ALL OTHER PLANS — AETNA/COVENTRY PPO-ALL OTHER PLANS : $524.40 AUXIANT CLARION SCHOOLS-ALL PLANS — AUXIANT CLARION SCHOOLS-ALL PLANS : $358.80 CIGNA-ALL PLANS — CIGNA-ALL PLANS : $535.44 HEALTH PARTNERS ISH-ALL OTHER PLANS — HEALTH PARTNERS ISH-ALL OTHER PLANS : $441.60 HEALTH PARTNERS PRESTAGE — HEALTH PARTNERS PRESTAGE : $414 HEALTHSCOPE STELLAR - ALL PLANS — HEALTHSCOPE STELLAR - ALL PLANS : $291.46 MIDLANDS CHOICE-ALL PLANS — MIDLANDS CHOICE-ALL PLANS : $535.44 TRICARE-ALL PLANS — TRICARE-ALL PLANS : $176.64 Diagnostic mammogram, both breasts CPT 77066 · Outpatient (no overnight stay) In the file: Diagnostic mammography of both breasts $454 $272.40 $145.28 – $440.38 Diagnostic mammogram, both breasts: 10 of 15 insurance plan rates AETNA/COVENTRY HMO — AETNA/COVENTRY HMO : $422.22 AETNA/COVENTRY MCR ADV — AETNA/COVENTRY MCR ADV : $145.28 AETNA/COVENTRY PPO-ALL OTHER PLANS — AETNA/COVENTRY PPO-ALL OTHER PLANS : $431.30 AUXIANT CLARION SCHOOLS-ALL PLANS — AUXIANT CLARION SCHOOLS-ALL PLANS : $295.10 CIGNA-ALL PLANS — CIGNA-ALL PLANS : $440.38 HEALTH PARTNERS ISH-ALL OTHER PLANS — HEALTH PARTNERS ISH-ALL OTHER PLANS : $363.20 HEALTH PARTNERS PRESTAGE — HEALTH PARTNERS PRESTAGE : $340.50 HEALTHSCOPE STELLAR - ALL PLANS — HEALTHSCOPE STELLAR - ALL PLANS : $239.71 MIDLANDS CHOICE-ALL PLANS — MIDLANDS CHOICE-ALL PLANS : $440.38 TRICARE-ALL PLANS — TRICARE-ALL PLANS : $145.28 Screening mammogram, both breasts CPT 77067 · Outpatient (no overnight stay) In the file: Screening mammography $572 $343.20 $183.04 – $554.84 Screening mammogram, both breasts: 10 of 15 insurance plan rates AETNA/COVENTRY HMO — AETNA/COVENTRY HMO : $531.96 AETNA/COVENTRY MCR ADV — AETNA/COVENTRY MCR ADV : $183.04 AETNA/COVENTRY PPO-ALL OTHER PLANS — AETNA/COVENTRY PPO-ALL OTHER PLANS : $543.40 AUXIANT CLARION SCHOOLS-ALL PLANS — AUXIANT CLARION SCHOOLS-ALL PLANS : $371.80 CIGNA-ALL PLANS — CIGNA-ALL PLANS : $554.84 HEALTH PARTNERS ISH-ALL OTHER PLANS — HEALTH PARTNERS ISH-ALL OTHER PLANS : $457.60 HEALTH PARTNERS PRESTAGE — HEALTH PARTNERS PRESTAGE : $429 HEALTHSCOPE STELLAR - ALL PLANS — HEALTHSCOPE STELLAR - ALL PLANS : $302.02 MIDLANDS CHOICE-ALL PLANS — MIDLANDS CHOICE-ALL PLANS : $554.84 TRICARE-ALL PLANS — TRICARE-ALL PLANS : $183.04
Heart tests and sleep study Service Hospital charge Cash price Insurance rates (lowest – highest) Electrocardiogram (ECG/EKG) with reading CPT 93000 · Outpatient (no overnight stay) In the file: Routine electrocardiogram (ECG) using at least 12 leads with interpretation and report $269 $161.40 $79.18 – $260.93 Electrocardiogram (ECG/EKG) with reading: 10 of 15 insurance plan rates AETNA/COVENTRY HMO — AETNA/COVENTRY HMO : $250.17 AETNA/COVENTRY MCR ADV — AETNA/COVENTRY MCR ADV : $86.08 AETNA/COVENTRY PPO-ALL OTHER PLANS — AETNA/COVENTRY PPO-ALL OTHER PLANS : $255.55 AUXIANT CLARION SCHOOLS-ALL PLANS — AUXIANT CLARION SCHOOLS-ALL PLANS : $174.85 CIGNA-ALL PLANS — CIGNA-ALL PLANS : $260.93 HEALTH PARTNERS ISH-ALL OTHER PLANS — HEALTH PARTNERS ISH-ALL OTHER PLANS : $215.20 HEALTH PARTNERS PRESTAGE — HEALTH PARTNERS PRESTAGE : $201.75 HEALTHSCOPE STELLAR - ALL PLANS — HEALTHSCOPE STELLAR - ALL PLANS : $142.03 MIDLANDS CHOICE-ALL PLANS — MIDLANDS CHOICE-ALL PLANS : $260.93 TRICARE-ALL PLANS — TRICARE-ALL PLANS : $86.08 Sleep study (overnight, in a sleep lab) CPT 95810 · Outpatient (no overnight stay) In the file: Sleep study in sleep lab (6 years or older) $4,160 $2,496 $1,331.20 – $4,035.20 Sleep study (overnight, in a sleep lab): 10 of 15 insurance plan rates AETNA/COVENTRY HMO — AETNA/COVENTRY HMO : $3,868.80 AETNA/COVENTRY MCR ADV — AETNA/COVENTRY MCR ADV : $1,331.20 AETNA/COVENTRY PPO-ALL OTHER PLANS — AETNA/COVENTRY PPO-ALL OTHER PLANS : $3,952 AUXIANT CLARION SCHOOLS-ALL PLANS — AUXIANT CLARION SCHOOLS-ALL PLANS : $2,704 CIGNA-ALL PLANS — CIGNA-ALL PLANS : $4,035.20 HEALTH PARTNERS ISH-ALL OTHER PLANS — HEALTH PARTNERS ISH-ALL OTHER PLANS : $3,328 HEALTH PARTNERS PRESTAGE — HEALTH PARTNERS PRESTAGE : $3,120 HEALTHSCOPE STELLAR - ALL PLANS — HEALTHSCOPE STELLAR - ALL PLANS : $2,196.48 MIDLANDS CHOICE-ALL PLANS — MIDLANDS CHOICE-ALL PLANS : $4,035.20 TRICARE-ALL PLANS — TRICARE-ALL PLANS : $1,331.20
Physical therapy and mental health Service Hospital charge Cash price Insurance rates (lowest – highest) Physical therapy: therapeutic exercise (each 15 minutes) CPT 97110 · Outpatient (no overnight stay) In the file: Therapy procedure using exercise to develop strength, endurance, range of motion, and flexibility, each 15 minutes $92 $55.20 $29.44 – $174.05 Physical therapy: therapeutic exercise (each 15 minutes): 10 of 15 insurance plan rates AETNA/COVENTRY HMO — AETNA/COVENTRY HMO : $85.56 AETNA/COVENTRY MCR ADV — AETNA/COVENTRY MCR ADV : $29.44 AETNA/COVENTRY PPO-ALL OTHER PLANS — AETNA/COVENTRY PPO-ALL OTHER PLANS : $87.40 AUXIANT CLARION SCHOOLS-ALL PLANS — AUXIANT CLARION SCHOOLS-ALL PLANS : $59.80 CIGNA-ALL PLANS — CIGNA-ALL PLANS : $89.24 HEALTH PARTNERS ISH-ALL OTHER PLANS — HEALTH PARTNERS ISH-ALL OTHER PLANS : $73.60 HEALTH PARTNERS PRESTAGE — HEALTH PARTNERS PRESTAGE : $69 HEALTHSCOPE STELLAR - ALL PLANS — HEALTHSCOPE STELLAR - ALL PLANS : $48.58 MIDLANDS CHOICE-ALL PLANS — MIDLANDS CHOICE-ALL PLANS : $89.24 TRICARE-ALL PLANS — TRICARE-ALL PLANS : $29.44 Physical therapy evaluation (low complexity) CPT 97161 · Outpatient (no overnight stay) In the file: Evaluation for physical therapy, typically 20 minutes $399 $239.40 $127.68 – $387.03 Physical therapy evaluation (low complexity): 10 of 15 insurance plan rates AETNA/COVENTRY HMO — AETNA/COVENTRY HMO : $371.07 AETNA/COVENTRY MCR ADV — AETNA/COVENTRY MCR ADV : $127.68 AETNA/COVENTRY PPO-ALL OTHER PLANS — AETNA/COVENTRY PPO-ALL OTHER PLANS : $379.05 AUXIANT CLARION SCHOOLS-ALL PLANS — AUXIANT CLARION SCHOOLS-ALL PLANS : $259.35 CIGNA-ALL PLANS — CIGNA-ALL PLANS : $387.03 HEALTH PARTNERS ISH-ALL OTHER PLANS — HEALTH PARTNERS ISH-ALL OTHER PLANS : $319.20 HEALTH PARTNERS PRESTAGE — HEALTH PARTNERS PRESTAGE : $299.25 HEALTHSCOPE STELLAR - ALL PLANS — HEALTHSCOPE STELLAR - ALL PLANS : $210.67 MIDLANDS CHOICE-ALL PLANS — MIDLANDS CHOICE-ALL PLANS : $387.03 TRICARE-ALL PLANS — TRICARE-ALL PLANS : $127.68 Physical therapy evaluation (moderate complexity) CPT 97162 · Outpatient (no overnight stay) In the file: Evaluation for physical therapy, typically 30 minutes $436 $261.60 $139.52 – $422.92 Physical therapy evaluation (moderate complexity): 10 of 15 insurance plan rates AETNA/COVENTRY HMO — AETNA/COVENTRY HMO : $405.48 AETNA/COVENTRY MCR ADV — AETNA/COVENTRY MCR ADV : $139.52 AETNA/COVENTRY PPO-ALL OTHER PLANS — AETNA/COVENTRY PPO-ALL OTHER PLANS : $414.20 AUXIANT CLARION SCHOOLS-ALL PLANS — AUXIANT CLARION SCHOOLS-ALL PLANS : $283.40 CIGNA-ALL PLANS — CIGNA-ALL PLANS : $422.92 HEALTH PARTNERS ISH-ALL OTHER PLANS — HEALTH PARTNERS ISH-ALL OTHER PLANS : $348.80 HEALTH PARTNERS PRESTAGE — HEALTH PARTNERS PRESTAGE : $327 HEALTHSCOPE STELLAR - ALL PLANS — HEALTHSCOPE STELLAR - ALL PLANS : $230.21 MIDLANDS CHOICE-ALL PLANS — MIDLANDS CHOICE-ALL PLANS : $422.92 TRICARE-ALL PLANS — TRICARE-ALL PLANS : $139.52 Physical therapy evaluation (high complexity) CPT 97163 · Outpatient (no overnight stay) In the file: Evaluation for physical therapy, typically 45 minutes $479 $287.40 $153.28 – $464.63 Physical therapy evaluation (high complexity): 10 of 15 insurance plan rates AETNA/COVENTRY HMO — AETNA/COVENTRY HMO : $445.47 AETNA/COVENTRY MCR ADV — AETNA/COVENTRY MCR ADV : $153.28 AETNA/COVENTRY PPO-ALL OTHER PLANS — AETNA/COVENTRY PPO-ALL OTHER PLANS : $455.05 AUXIANT CLARION SCHOOLS-ALL PLANS — AUXIANT CLARION SCHOOLS-ALL PLANS : $311.35 CIGNA-ALL PLANS — CIGNA-ALL PLANS : $464.63 HEALTH PARTNERS ISH-ALL OTHER PLANS — HEALTH PARTNERS ISH-ALL OTHER PLANS : $383.20 HEALTH PARTNERS PRESTAGE — HEALTH PARTNERS PRESTAGE : $359.25 HEALTHSCOPE STELLAR - ALL PLANS — HEALTHSCOPE STELLAR - ALL PLANS : $252.91 MIDLANDS CHOICE-ALL PLANS — MIDLANDS CHOICE-ALL PLANS : $464.63 TRICARE-ALL PLANS — TRICARE-ALL PLANS : $153.28 Psychotherapy, 30 minutes CPT 90832 · Outpatient (no overnight stay) In the file: Psychotherapy, 30 minutes $145 $87 $61.93 – $113.69 Psychotherapy, 30 minutes: 10 of 15 insurance plan rates AETNA/COVENTRY HMO — AETNA/COVENTRY HMO : $61.93 AETNA/COVENTRY MCR ADV — AETNA/COVENTRY MCR ADV : $68.90 AETNA/COVENTRY PPO-ALL OTHER PLANS — AETNA/COVENTRY PPO-ALL OTHER PLANS : $61.93 AUXIANT CLARION SCHOOLS-ALL PLANS — AUXIANT CLARION SCHOOLS-ALL PLANS : $94.25 CIGNA-ALL PLANS — CIGNA-ALL PLANS : $80.48 HEALTH PARTNERS ISH-ALL OTHER PLANS — HEALTH PARTNERS ISH-ALL OTHER PLANS : $84.14 HEALTH PARTNERS PRESTAGE — HEALTH PARTNERS PRESTAGE : $108.75 HEALTHSCOPE STELLAR - ALL PLANS — HEALTHSCOPE STELLAR - ALL PLANS : $113.69 MIDLANDS CHOICE-ALL PLANS — MIDLANDS CHOICE-ALL PLANS : $80.48 TRICARE-ALL PLANS — TRICARE-ALL PLANS : $68.90 Psychotherapy, 45 minutes CPT 90834 · Outpatient (no overnight stay) In the file: Psychotherapy, 45 minutes $168 $100.80 $82.57 – $150.10 Psychotherapy, 45 minutes: 10 of 15 insurance plan rates AETNA/COVENTRY HMO — AETNA/COVENTRY HMO : $82.57 AETNA/COVENTRY MCR ADV — AETNA/COVENTRY MCR ADV : $90.97 AETNA/COVENTRY PPO-ALL OTHER PLANS — AETNA/COVENTRY PPO-ALL OTHER PLANS : $82.57 AUXIANT CLARION SCHOOLS-ALL PLANS — AUXIANT CLARION SCHOOLS-ALL PLANS : $109.20 CIGNA-ALL PLANS — CIGNA-ALL PLANS : $107.45 HEALTH PARTNERS ISH-ALL OTHER PLANS — HEALTH PARTNERS ISH-ALL OTHER PLANS : $112.36 HEALTH PARTNERS PRESTAGE — HEALTH PARTNERS PRESTAGE : $126 HEALTHSCOPE STELLAR - ALL PLANS — HEALTHSCOPE STELLAR - ALL PLANS : $150.10 MIDLANDS CHOICE-ALL PLANS — MIDLANDS CHOICE-ALL PLANS : $107.45 TRICARE-ALL PLANS — TRICARE-ALL PLANS : $90.97 Psychotherapy, 60 minutes CPT 90837 · Outpatient (no overnight stay) In the file: Psychotherapy, 1 hour $241 $144.60 $123.70 – $221.36 Psychotherapy, 60 minutes: 10 of 15 insurance plan rates AETNA/COVENTRY HMO — AETNA/COVENTRY HMO : $123.70 AETNA/COVENTRY MCR ADV — AETNA/COVENTRY MCR ADV : $134.16 AETNA/COVENTRY PPO-ALL OTHER PLANS — AETNA/COVENTRY PPO-ALL OTHER PLANS : $123.70 AUXIANT CLARION SCHOOLS-ALL PLANS — AUXIANT CLARION SCHOOLS-ALL PLANS : $156.65 CIGNA-ALL PLANS — CIGNA-ALL PLANS : $147.93 HEALTH PARTNERS ISH-ALL OTHER PLANS — HEALTH PARTNERS ISH-ALL OTHER PLANS : $169.30 HEALTH PARTNERS PRESTAGE — HEALTH PARTNERS PRESTAGE : $180.75 HEALTHSCOPE STELLAR - ALL PLANS — HEALTHSCOPE STELLAR - ALL PLANS : $221.36 MIDLANDS CHOICE-ALL PLANS — MIDLANDS CHOICE-ALL PLANS : $147.93 TRICARE-ALL PLANS — TRICARE-ALL PLANS : $134.16 Family psychotherapy, without the patient CPT 90846 · Outpatient (no overnight stay) In the file: Family psychotherapy without patient, 50 minutes $204 $122.40 $98.03 – $175.35 Family psychotherapy, without the patient: 10 of 15 insurance plan rates AETNA/COVENTRY HMO — AETNA/COVENTRY HMO : $99.78 AETNA/COVENTRY MCR ADV — AETNA/COVENTRY MCR ADV : $98.03 AETNA/COVENTRY PPO-ALL OTHER PLANS — AETNA/COVENTRY PPO-ALL OTHER PLANS : $99.78 AUXIANT CLARION SCHOOLS-ALL PLANS — AUXIANT CLARION SCHOOLS-ALL PLANS : $132.60 CIGNA-ALL PLANS — CIGNA-ALL PLANS : $132.45 HEALTH PARTNERS ISH-ALL OTHER PLANS — HEALTH PARTNERS ISH-ALL OTHER PLANS : $141.07 HEALTH PARTNERS PRESTAGE — HEALTH PARTNERS PRESTAGE : $153 HEALTHSCOPE STELLAR - ALL PLANS — HEALTHSCOPE STELLAR - ALL PLANS : $161.75 MIDLANDS CHOICE-ALL PLANS — MIDLANDS CHOICE-ALL PLANS : $132.45 TRICARE-ALL PLANS — TRICARE-ALL PLANS : $98.03 Family psychotherapy, with the patient CPT 90847 · Outpatient (no overnight stay) In the file: Family psychotherapy with patient, 50 minutes $213 $127.80 $101.90 – $182.27 Family psychotherapy, with the patient: 10 of 15 insurance plan rates AETNA/COVENTRY HMO — AETNA/COVENTRY HMO : $103.71 AETNA/COVENTRY MCR ADV — AETNA/COVENTRY MCR ADV : $101.90 AETNA/COVENTRY PPO-ALL OTHER PLANS — AETNA/COVENTRY PPO-ALL OTHER PLANS : $103.71 AUXIANT CLARION SCHOOLS-ALL PLANS — AUXIANT CLARION SCHOOLS-ALL PLANS : $138.45 CIGNA-ALL PLANS — CIGNA-ALL PLANS : $157.72 HEALTH PARTNERS ISH-ALL OTHER PLANS — HEALTH PARTNERS ISH-ALL OTHER PLANS : $167.91 HEALTH PARTNERS PRESTAGE — HEALTH PARTNERS PRESTAGE : $159.75 HEALTHSCOPE STELLAR - ALL PLANS — HEALTHSCOPE STELLAR - ALL PLANS : $168.14 MIDLANDS CHOICE-ALL PLANS — MIDLANDS CHOICE-ALL PLANS : $157.72 TRICARE-ALL PLANS — TRICARE-ALL PLANS : $101.90 Group psychotherapy CPT 90853 · Outpatient (no overnight stay) In the file: Group psychotherapy $258 $154.80 $82.56 – $250.26 Group psychotherapy: 10 of 15 insurance plan rates AETNA/COVENTRY HMO — AETNA/COVENTRY HMO : $239.94 AETNA/COVENTRY MCR ADV — AETNA/COVENTRY MCR ADV : $82.56 AETNA/COVENTRY PPO-ALL OTHER PLANS — AETNA/COVENTRY PPO-ALL OTHER PLANS : $245.10 AUXIANT CLARION SCHOOLS-ALL PLANS — AUXIANT CLARION SCHOOLS-ALL PLANS : $167.70 CIGNA-ALL PLANS — CIGNA-ALL PLANS : $250.26 HEALTH PARTNERS ISH-ALL OTHER PLANS — HEALTH PARTNERS ISH-ALL OTHER PLANS : $206.40 HEALTH PARTNERS PRESTAGE — HEALTH PARTNERS PRESTAGE : $193.50 HEALTHSCOPE STELLAR - ALL PLANS — HEALTHSCOPE STELLAR - ALL PLANS : $136.22 MIDLANDS CHOICE-ALL PLANS — MIDLANDS CHOICE-ALL PLANS : $250.26 TRICARE-ALL PLANS — TRICARE-ALL PLANS : $82.56
Procedures and surgery Service Hospital charge Cash price Insurance rates (lowest – highest) Removal of breast growth (open surgery) CPT 19120 · Outpatient (no overnight stay) In the file: Removal of growth and tissue of breast, duct, or nipple $1,633 $979.80 $364.45 – $1,224.75 Removal of breast growth (open surgery): 10 of 15 insurance plan rates AETNA/COVENTRY HMO — AETNA/COVENTRY HMO : $388.44 AETNA/COVENTRY MCR ADV — AETNA/COVENTRY MCR ADV : $364.45 AETNA/COVENTRY PPO-ALL OTHER PLANS — AETNA/COVENTRY PPO-ALL OTHER PLANS : $388.44 AUXIANT CLARION SCHOOLS-ALL PLANS — AUXIANT CLARION SCHOOLS-ALL PLANS : $1,061.45 CIGNA-ALL PLANS — CIGNA-ALL PLANS : $853.27 HEALTH PARTNERS ISH-ALL OTHER PLANS — HEALTH PARTNERS ISH-ALL OTHER PLANS : $729.09 HEALTH PARTNERS PRESTAGE — HEALTH PARTNERS PRESTAGE : $1,224.75 HEALTHSCOPE STELLAR - ALL PLANS — HEALTHSCOPE STELLAR - ALL PLANS : $601.34 MIDLANDS CHOICE-ALL PLANS — MIDLANDS CHOICE-ALL PLANS : $853.27 TRICARE-ALL PLANS — TRICARE-ALL PLANS : $364.45 Knee arthroscopy: removal of torn cartilage (meniscus) CPT 29881 · Outpatient (no overnight stay) In the file: Removal of knee cartilage using an endoscope $4,028 $2,416.80 $467.10 – $3,021 Knee arthroscopy: removal of torn cartilage (meniscus): 10 of 15 insurance plan rates AETNA/COVENTRY HMO — AETNA/COVENTRY HMO : $510.53 AETNA/COVENTRY MCR ADV — AETNA/COVENTRY MCR ADV : $467.10 AETNA/COVENTRY PPO-ALL OTHER PLANS — AETNA/COVENTRY PPO-ALL OTHER PLANS : $510.53 AUXIANT CLARION SCHOOLS-ALL PLANS — AUXIANT CLARION SCHOOLS-ALL PLANS : $2,618.20 CIGNA-ALL PLANS — CIGNA-ALL PLANS : $1,126 HEALTH PARTNERS ISH-ALL OTHER PLANS — HEALTH PARTNERS ISH-ALL OTHER PLANS : $986.77 HEALTH PARTNERS PRESTAGE — HEALTH PARTNERS PRESTAGE : $3,021 HEALTHSCOPE STELLAR - ALL PLANS — HEALTHSCOPE STELLAR - ALL PLANS : $770.72 MIDLANDS CHOICE-ALL PLANS — MIDLANDS CHOICE-ALL PLANS : $1,126 TRICARE-ALL PLANS — TRICARE-ALL PLANS : $467.10 Removal of tonsils and adenoids (under age 12) CPT 42820 · Outpatient (no overnight stay) In the file: Removal of tonsils and adenoid glands (younger than 12 years) $1,000 $600 $240.15 – $750 Removal of tonsils and adenoids (under age 12): 10 of 15 insurance plan rates AETNA/COVENTRY HMO — AETNA/COVENTRY HMO : $274.60 AETNA/COVENTRY MCR ADV — AETNA/COVENTRY MCR ADV : $240.15 AETNA/COVENTRY PPO-ALL OTHER PLANS — AETNA/COVENTRY PPO-ALL OTHER PLANS : $274.60 AUXIANT CLARION SCHOOLS-ALL PLANS — AUXIANT CLARION SCHOOLS-ALL PLANS : $650 CIGNA-ALL PLANS — CIGNA-ALL PLANS : $596.20 HEALTH PARTNERS ISH-ALL OTHER PLANS — HEALTH PARTNERS ISH-ALL OTHER PLANS : $535.51 HEALTH PARTNERS PRESTAGE — HEALTH PARTNERS PRESTAGE : $750 HEALTHSCOPE STELLAR - ALL PLANS — HEALTHSCOPE STELLAR - ALL PLANS : $396.25 MIDLANDS CHOICE-ALL PLANS — MIDLANDS CHOICE-ALL PLANS : $596.20 TRICARE-ALL PLANS — TRICARE-ALL PLANS : $240.15 Upper GI endoscopy (diagnostic) CPT 43235 · Outpatient (no overnight stay) In the file: Diagnostic exam of esophagus, stomach, and/or upper small bowel using a flexible endoscope $1,285 $771 $102.80 – $963.75 Upper GI endoscopy (diagnostic): 10 of 15 insurance plan rates AETNA/COVENTRY HMO — AETNA/COVENTRY HMO : $118.36 AETNA/COVENTRY MCR ADV — AETNA/COVENTRY MCR ADV : $102.80 AETNA/COVENTRY PPO-ALL OTHER PLANS — AETNA/COVENTRY PPO-ALL OTHER PLANS : $118.36 AUXIANT CLARION SCHOOLS-ALL PLANS — AUXIANT CLARION SCHOOLS-ALL PLANS : $835.25 CIGNA-ALL PLANS — CIGNA-ALL PLANS : $255.52 HEALTH PARTNERS ISH-ALL OTHER PLANS — HEALTH PARTNERS ISH-ALL OTHER PLANS : $265.62 HEALTH PARTNERS PRESTAGE — HEALTH PARTNERS PRESTAGE : $963.75 HEALTHSCOPE STELLAR - ALL PLANS — HEALTHSCOPE STELLAR - ALL PLANS : $169.62 MIDLANDS CHOICE-ALL PLANS — MIDLANDS CHOICE-ALL PLANS : $255.52 TRICARE-ALL PLANS — TRICARE-ALL PLANS : $102.80 Upper GI endoscopy with biopsy CPT 43239 · Outpatient (no overnight stay) In the file: Biopsy of esophagus, stomach, and/or upper small bowel using a flexible endoscope $1,298 $778.80 $115.02 – $973.50 Upper GI endoscopy with biopsy: 10 of 15 insurance plan rates AETNA/COVENTRY HMO — AETNA/COVENTRY HMO : $133.75 AETNA/COVENTRY MCR ADV — AETNA/COVENTRY MCR ADV : $115.02 AETNA/COVENTRY PPO-ALL OTHER PLANS — AETNA/COVENTRY PPO-ALL OTHER PLANS : $133.75 AUXIANT CLARION SCHOOLS-ALL PLANS — AUXIANT CLARION SCHOOLS-ALL PLANS : $843.70 CIGNA-ALL PLANS — CIGNA-ALL PLANS : $288 HEALTH PARTNERS ISH-ALL OTHER PLANS — HEALTH PARTNERS ISH-ALL OTHER PLANS : $313.25 HEALTH PARTNERS PRESTAGE — HEALTH PARTNERS PRESTAGE : $973.50 HEALTHSCOPE STELLAR - ALL PLANS — HEALTHSCOPE STELLAR - ALL PLANS : $189.78 MIDLANDS CHOICE-ALL PLANS — MIDLANDS CHOICE-ALL PLANS : $288 TRICARE-ALL PLANS — TRICARE-ALL PLANS : $115.02 Colonoscopy (diagnostic) CPT 45378 · Outpatient (no overnight stay) In the file: Diagnostic exam of large bowel using a flexible endoscope $1,285 $771 $152.60 – $963.75 Colonoscopy (diagnostic): 10 of 15 insurance plan rates AETNA/COVENTRY HMO — AETNA/COVENTRY HMO : $178.92 AETNA/COVENTRY MCR ADV — AETNA/COVENTRY MCR ADV : $152.60 AETNA/COVENTRY PPO-ALL OTHER PLANS — AETNA/COVENTRY PPO-ALL OTHER PLANS : $178.92 AUXIANT CLARION SCHOOLS-ALL PLANS — AUXIANT CLARION SCHOOLS-ALL PLANS : $835.25 CIGNA-ALL PLANS — CIGNA-ALL PLANS : $386.16 HEALTH PARTNERS ISH-ALL OTHER PLANS — HEALTH PARTNERS ISH-ALL OTHER PLANS : $395.68 HEALTH PARTNERS PRESTAGE — HEALTH PARTNERS PRESTAGE : $963.75 HEALTHSCOPE STELLAR - ALL PLANS — HEALTHSCOPE STELLAR - ALL PLANS : $251.79 MIDLANDS CHOICE-ALL PLANS — MIDLANDS CHOICE-ALL PLANS : $386.16 TRICARE-ALL PLANS — TRICARE-ALL PLANS : $152.60 Colonoscopy with biopsy CPT 45380 · Outpatient (no overnight stay) In the file: Biopsy of large bowel using a flexible endoscope $1,403 $841.80 $165.17 – $1,052.25 Colonoscopy with biopsy: 10 of 15 insurance plan rates AETNA/COVENTRY HMO — AETNA/COVENTRY HMO : $194.33 AETNA/COVENTRY MCR ADV — AETNA/COVENTRY MCR ADV : $165.17 AETNA/COVENTRY PPO-ALL OTHER PLANS — AETNA/COVENTRY PPO-ALL OTHER PLANS : $194.33 AUXIANT CLARION SCHOOLS-ALL PLANS — AUXIANT CLARION SCHOOLS-ALL PLANS : $911.95 CIGNA-ALL PLANS — CIGNA-ALL PLANS : $417.92 HEALTH PARTNERS ISH-ALL OTHER PLANS — HEALTH PARTNERS ISH-ALL OTHER PLANS : $473.23 HEALTH PARTNERS PRESTAGE — HEALTH PARTNERS PRESTAGE : $1,052.25 HEALTHSCOPE STELLAR - ALL PLANS — HEALTHSCOPE STELLAR - ALL PLANS : $272.53 MIDLANDS CHOICE-ALL PLANS — MIDLANDS CHOICE-ALL PLANS : $417.92 TRICARE-ALL PLANS — TRICARE-ALL PLANS : $165.17 Colonoscopy with removal of polyps (snare) CPT 45385 · Outpatient (no overnight stay) In the file: Removal of polyps or growths of large bowel using an endoscope with mechanical snare $1,801 $1,080.60 $208.30 – $1,350.75 Colonoscopy with removal of polyps (snare): 10 of 15 insurance plan rates AETNA/COVENTRY HMO — AETNA/COVENTRY HMO : $246.86 AETNA/COVENTRY MCR ADV — AETNA/COVENTRY MCR ADV : $208.30 AETNA/COVENTRY PPO-ALL OTHER PLANS — AETNA/COVENTRY PPO-ALL OTHER PLANS : $246.86 AUXIANT CLARION SCHOOLS-ALL PLANS — AUXIANT CLARION SCHOOLS-ALL PLANS : $1,170.65 CIGNA-ALL PLANS — CIGNA-ALL PLANS : $530.52 HEALTH PARTNERS ISH-ALL OTHER PLANS — HEALTH PARTNERS ISH-ALL OTHER PLANS : $561.17 HEALTH PARTNERS PRESTAGE — HEALTH PARTNERS PRESTAGE : $1,350.75 HEALTHSCOPE STELLAR - ALL PLANS — HEALTHSCOPE STELLAR - ALL PLANS : $343.70 MIDLANDS CHOICE-ALL PLANS — MIDLANDS CHOICE-ALL PLANS : $530.52 TRICARE-ALL PLANS — TRICARE-ALL PLANS : $208.30 Screening colonoscopy (not high risk) HCPCS G0121 · Outpatient (no overnight stay) In the file: COLORECTAL CANCER SCREENING; COLONOSCOPY ON INDIVIDUAL NOT MEETING CRITERIA FOR HIGH RISK $1,121 $672.60 $152.74 – $840.75 Screening colonoscopy (not high risk): 10 of 15 insurance plan rates AETNA/COVENTRY HMO — AETNA/COVENTRY HMO : $179.07 AETNA/COVENTRY MCR ADV — AETNA/COVENTRY MCR ADV : $152.74 AETNA/COVENTRY PPO-ALL OTHER PLANS — AETNA/COVENTRY PPO-ALL OTHER PLANS : $179.07 AUXIANT CLARION SCHOOLS-ALL PLANS — AUXIANT CLARION SCHOOLS-ALL PLANS : $728.65 CIGNA-ALL PLANS — CIGNA-ALL PLANS : $386.88 HEALTH PARTNERS ISH-ALL OTHER PLANS — HEALTH PARTNERS ISH-ALL OTHER PLANS : $349.92 HEALTH PARTNERS PRESTAGE — HEALTH PARTNERS PRESTAGE : $840.75 HEALTHSCOPE STELLAR - ALL PLANS — HEALTHSCOPE STELLAR - ALL PLANS : $252.02 MIDLANDS CHOICE-ALL PLANS — MIDLANDS CHOICE-ALL PLANS : $386.88 TRICARE-ALL PLANS — TRICARE-ALL PLANS : $152.74 Gallbladder removal by laparoscope CPT 47562 · Outpatient (no overnight stay) In the file: Removal of gallbladder using an endoscope $2,082 $1,249.20 $561.02 – $1,575.76 Gallbladder removal by laparoscope: 10 of 15 insurance plan rates AETNA/COVENTRY HMO — AETNA/COVENTRY HMO : $619.71 AETNA/COVENTRY MCR ADV — AETNA/COVENTRY MCR ADV : $561.02 AETNA/COVENTRY PPO-ALL OTHER PLANS — AETNA/COVENTRY PPO-ALL OTHER PLANS : $619.71 AUXIANT CLARION SCHOOLS-ALL PLANS — AUXIANT CLARION SCHOOLS-ALL PLANS : $1,353.30 CIGNA-ALL PLANS — CIGNA-ALL PLANS : $1,365.38 HEALTH PARTNERS ISH-ALL OTHER PLANS — HEALTH PARTNERS ISH-ALL OTHER PLANS : $1,334.22 HEALTH PARTNERS PRESTAGE — HEALTH PARTNERS PRESTAGE : $1,561.50 HEALTHSCOPE STELLAR - ALL PLANS — HEALTHSCOPE STELLAR - ALL PLANS : $925.68 MIDLANDS CHOICE-ALL PLANS — MIDLANDS CHOICE-ALL PLANS : $1,365.38 TRICARE-ALL PLANS — TRICARE-ALL PLANS : $561.02 Groin (inguinal) hernia repair, age 5 or older CPT 49505 · Outpatient (no overnight stay) In the file: Repair of groin hernia (5 years or older) $1,985 $1,191 $451.41 – $1,488.75 Groin (inguinal) hernia repair, age 5 or older: 10 of 15 insurance plan rates AETNA/COVENTRY HMO — AETNA/COVENTRY HMO : $490.33 AETNA/COVENTRY MCR ADV — AETNA/COVENTRY MCR ADV : $451.41 AETNA/COVENTRY PPO-ALL OTHER PLANS — AETNA/COVENTRY PPO-ALL OTHER PLANS : $490.33 AUXIANT CLARION SCHOOLS-ALL PLANS — AUXIANT CLARION SCHOOLS-ALL PLANS : $1,290.25 CIGNA-ALL PLANS — CIGNA-ALL PLANS : $1,079 HEALTH PARTNERS ISH-ALL OTHER PLANS — HEALTH PARTNERS ISH-ALL OTHER PLANS : $925.09 HEALTH PARTNERS PRESTAGE — HEALTH PARTNERS PRESTAGE : $1,488.75 HEALTHSCOPE STELLAR - ALL PLANS — HEALTHSCOPE STELLAR - ALL PLANS : $744.83 MIDLANDS CHOICE-ALL PLANS — MIDLANDS CHOICE-ALL PLANS : $1,079 TRICARE-ALL PLANS — TRICARE-ALL PLANS : $451.41 Prostate biopsy CPT 55700 · Outpatient (no overnight stay) In the file: Biopsy of prostate gland $8,200 $4,920 $2,624 – $7,954 Prostate biopsy: 10 of 15 insurance plan rates AETNA/COVENTRY HMO — AETNA/COVENTRY HMO : $7,626 AETNA/COVENTRY MCR ADV — AETNA/COVENTRY MCR ADV : $2,624 AETNA/COVENTRY PPO-ALL OTHER PLANS — AETNA/COVENTRY PPO-ALL OTHER PLANS : $7,790 AUXIANT CLARION SCHOOLS-ALL PLANS — AUXIANT CLARION SCHOOLS-ALL PLANS : $5,330 CIGNA-ALL PLANS — CIGNA-ALL PLANS : $7,954 HEALTH PARTNERS ISH-ALL OTHER PLANS — HEALTH PARTNERS ISH-ALL OTHER PLANS : $6,560 HEALTH PARTNERS PRESTAGE — HEALTH PARTNERS PRESTAGE : $6,150 HEALTHSCOPE STELLAR - ALL PLANS — HEALTHSCOPE STELLAR - ALL PLANS : $4,329.60 MIDLANDS CHOICE-ALL PLANS — MIDLANDS CHOICE-ALL PLANS : $7,954 TRICARE-ALL PLANS — TRICARE-ALL PLANS : $2,624 Hysteroscopy with biopsy of the uterus lining CPT 58558 · Outpatient (no overnight stay) In the file: Biopsy of lining of uterus and/or removal of polyp using an endoscope $935 $561 $186.14 – $701.25 Hysteroscopy with biopsy of the uterus lining: 10 of 15 insurance plan rates AETNA/COVENTRY HMO — AETNA/COVENTRY HMO : $223.46 AETNA/COVENTRY MCR ADV — AETNA/COVENTRY MCR ADV : $186.14 AETNA/COVENTRY PPO-ALL OTHER PLANS — AETNA/COVENTRY PPO-ALL OTHER PLANS : $223.46 AUXIANT CLARION SCHOOLS-ALL PLANS — AUXIANT CLARION SCHOOLS-ALL PLANS : $607.75 CIGNA-ALL PLANS — CIGNA-ALL PLANS : $275.82 HEALTH PARTNERS ISH-ALL OTHER PLANS — HEALTH PARTNERS ISH-ALL OTHER PLANS : $486.67 HEALTH PARTNERS PRESTAGE — HEALTH PARTNERS PRESTAGE : $701.25 HEALTHSCOPE STELLAR - ALL PLANS — HEALTHSCOPE STELLAR - ALL PLANS : $307.13 MIDLANDS CHOICE-ALL PLANS — MIDLANDS CHOICE-ALL PLANS : $275.82 TRICARE-ALL PLANS — TRICARE-ALL PLANS : $186.14 Spinal injection, lower back (epidural), with imaging guidance CPT 62323 · Outpatient (no overnight stay) In the file: Injection of substance into lower spine canal using imaging guidance $2,987 $1,792.20 $955.84 – $2,897.39 Spinal injection, lower back (epidural), with imaging guidance: 10 of 15 insurance plan rates AETNA/COVENTRY HMO — AETNA/COVENTRY HMO : $2,777.91 AETNA/COVENTRY MCR ADV — AETNA/COVENTRY MCR ADV : $955.84 AETNA/COVENTRY PPO-ALL OTHER PLANS — AETNA/COVENTRY PPO-ALL OTHER PLANS : $2,837.65 AUXIANT CLARION SCHOOLS-ALL PLANS — AUXIANT CLARION SCHOOLS-ALL PLANS : $1,941.55 CIGNA-ALL PLANS — CIGNA-ALL PLANS : $2,897.39 HEALTH PARTNERS ISH-ALL OTHER PLANS — HEALTH PARTNERS ISH-ALL OTHER PLANS : $2,389.60 HEALTH PARTNERS PRESTAGE — HEALTH PARTNERS PRESTAGE : $2,240.25 HEALTHSCOPE STELLAR - ALL PLANS — HEALTHSCOPE STELLAR - ALL PLANS : $1,577.14 MIDLANDS CHOICE-ALL PLANS — MIDLANDS CHOICE-ALL PLANS : $2,897.39 TRICARE-ALL PLANS — TRICARE-ALL PLANS : $955.84 Nerve root injection, lower back, with imaging guidance CPT 64483 · Outpatient (no overnight stay) In the file: Injection of anesthetic and/or steroid drug into sacral spine nerve root using imaging guidance, single level $3,193 $1,915.80 $1,021.76 – $3,097.21 Nerve root injection, lower back, with imaging guidance: 10 of 15 insurance plan rates AETNA/COVENTRY HMO — AETNA/COVENTRY HMO : $2,969.49 AETNA/COVENTRY MCR ADV — AETNA/COVENTRY MCR ADV : $1,021.76 AETNA/COVENTRY PPO-ALL OTHER PLANS — AETNA/COVENTRY PPO-ALL OTHER PLANS : $3,033.35 AUXIANT CLARION SCHOOLS-ALL PLANS — AUXIANT CLARION SCHOOLS-ALL PLANS : $2,075.45 CIGNA-ALL PLANS — CIGNA-ALL PLANS : $3,097.21 HEALTH PARTNERS ISH-ALL OTHER PLANS — HEALTH PARTNERS ISH-ALL OTHER PLANS : $2,554.40 HEALTH PARTNERS PRESTAGE — HEALTH PARTNERS PRESTAGE : $2,394.75 HEALTHSCOPE STELLAR - ALL PLANS — HEALTHSCOPE STELLAR - ALL PLANS : $1,685.90 MIDLANDS CHOICE-ALL PLANS — MIDLANDS CHOICE-ALL PLANS : $3,097.21 TRICARE-ALL PLANS — TRICARE-ALL PLANS : $1,021.76 Carpal tunnel release CPT 64721 · Outpatient (no overnight stay) In the file: Release and/or relocation of hand nerve $5,356 $3,213.60 $1,713.92 – $5,195.32 Carpal tunnel release: 10 of 15 insurance plan rates AETNA/COVENTRY HMO — AETNA/COVENTRY HMO : $4,981.08 AETNA/COVENTRY MCR ADV — AETNA/COVENTRY MCR ADV : $1,713.92 AETNA/COVENTRY PPO-ALL OTHER PLANS — AETNA/COVENTRY PPO-ALL OTHER PLANS : $5,088.20 AUXIANT CLARION SCHOOLS-ALL PLANS — AUXIANT CLARION SCHOOLS-ALL PLANS : $3,481.40 CIGNA-ALL PLANS — CIGNA-ALL PLANS : $5,195.32 HEALTH PARTNERS ISH-ALL OTHER PLANS — HEALTH PARTNERS ISH-ALL OTHER PLANS : $4,284.80 HEALTH PARTNERS PRESTAGE — HEALTH PARTNERS PRESTAGE : $4,017 HEALTHSCOPE STELLAR - ALL PLANS — HEALTHSCOPE STELLAR - ALL PLANS : $2,827.97 MIDLANDS CHOICE-ALL PLANS — MIDLANDS CHOICE-ALL PLANS : $5,195.32 TRICARE-ALL PLANS — TRICARE-ALL PLANS : $1,713.92
Hospital stays (whole stay, MS-DRG) Service Hospital charge Cash price Insurance rates (lowest – highest) Spinal fusion (not neck), without major complications MS-DRG 460 · Inpatient (hospital stay) In the file: SPINAL FUSION EXCEPT CERVICAL WITHOUT MCC $420,895.43 $252,537.26 $32,970 – $408,268.57 Spinal fusion (not neck), without major complications: 10 of 15 insurance plan rates AETNA/COVENTRY HMO — AETNA/COVENTRY HMO : $391,432.75 AETNA/COVENTRY MCR ADV — AETNA/COVENTRY MCR ADV : $32,970 AETNA/COVENTRY PPO-ALL OTHER PLANS — AETNA/COVENTRY PPO-ALL OTHER PLANS : $399,850.66 AUXIANT CLARION SCHOOLS-ALL PLANS — AUXIANT CLARION SCHOOLS-ALL PLANS : $273,582.03 CIGNA-ALL PLANS — CIGNA-ALL PLANS : $408,268.57 HEALTH PARTNERS ISH-ALL OTHER PLANS — HEALTH PARTNERS ISH-ALL OTHER PLANS : $336,716.35 HEALTH PARTNERS PRESTAGE — HEALTH PARTNERS PRESTAGE : $315,671.58 HEALTHSCOPE STELLAR - ALL PLANS — HEALTHSCOPE STELLAR - ALL PLANS : $54,400.50 MIDLANDS CHOICE-ALL PLANS — MIDLANDS CHOICE-ALL PLANS : $408,268.57 TRICARE-ALL PLANS — TRICARE-ALL PLANS : $32,970 Neck (cervical) spinal fusion, without complications MS-DRG 473 · Inpatient (hospital stay) In the file: CERVICAL SPINAL FUSION WITHOUT CC/MCC $135,340.47 $81,204.28 $16,485 – $131,280.26 Neck (cervical) spinal fusion, without complications: 10 of 15 insurance plan rates AETNA/COVENTRY HMO — AETNA/COVENTRY HMO : $125,866.64 AETNA/COVENTRY MCR ADV — AETNA/COVENTRY MCR ADV : $16,485 AETNA/COVENTRY PPO-ALL OTHER PLANS — AETNA/COVENTRY PPO-ALL OTHER PLANS : $128,573.45 AUXIANT CLARION SCHOOLS-ALL PLANS — AUXIANT CLARION SCHOOLS-ALL PLANS : $87,971.31 CIGNA-ALL PLANS — CIGNA-ALL PLANS : $131,280.26 HEALTH PARTNERS ISH-ALL OTHER PLANS — HEALTH PARTNERS ISH-ALL OTHER PLANS : $108,272.38 HEALTH PARTNERS PRESTAGE — HEALTH PARTNERS PRESTAGE : $101,505.35 HEALTHSCOPE STELLAR - ALL PLANS — HEALTHSCOPE STELLAR - ALL PLANS : $27,200.25 MIDLANDS CHOICE-ALL PLANS — MIDLANDS CHOICE-ALL PLANS : $131,280.26 TRICARE-ALL PLANS — TRICARE-ALL PLANS : $16,485
Source: Iowa Specialty Hospital - Belmond’s standard charges file (apps.para-hcfs.com, CSV, CMS template 3.0.0; it can be a very large file), last updated by the hospital on April 22, 2026; retrieved November 1, 2026. The hospital’s price transparency page →
Found through the hospital’s cms-hpt.txt file, as required by the federal hospital price transparency rule (CMS) . We show a selection of common services; the file has every item and service.